Rome, GA · Floyd County
Title VI Complaint Form
This form lets a person report alleged discrimination by the Rome Transit Department under Title VI and submit the complaint to the city or planning department.
What this form is
The Title VI Complaint Form is for people who believe they experienced discrimination under Title VI involving the Rome Transit Department. It asks for the complainant’s contact information, details about the alleged discrimination, and information about any prior complaints. The form also requests the name of the agency complained against and requires a signature and date.
Who needs it
A person who believes they experienced unlawful discrimination under Title VI by the Rome Transit Department can file this complaint form.
How to submit it
Submit the signed form in person at 168 North Avenue or 607 Broad Street, or mail it to Courtnay Griffin or Brice Wood at the listed department addresses.
About notarization
This complaint form is signed and dated without a notary; any written supporting materials are optional and are not identified as notarized or sworn.
How to submit this form
- 1
Download The Form
Download the Title VI Complaint Form.
- 2
Complete The Form
Provide your contact details and information about the alleged discrimination and people involved.
- 3
Gather Optional Materials
Attach any written materials or other information you think is relevant to your complaint.
- 4
Sign And Date
Sign and date the form.
- 5
Submit The Form
Submit it in person or by mail to Courtnay Griffin or Brice Wood at the addresses listed on the form.
Frequently asked questions
- Who can file the Title VI Complaint Form?
- A person who believes they experienced an unlawful discriminatory practice under Title VI involving the Rome Transit Department may file a complaint.
- What information does the Title VI Complaint Form request?
- It asks for contact details, information about the alleged discrimination and people involved, prior complaint details, the agency complained against, and a signature and date.
- Do I need a notary for the Title VI Complaint Form?
- No. The form requires a signature and date, not notarization. Optional written supporting materials are not identified as notarized or sworn.
- How do I submit the Title VI Complaint Form?
- The form says to submit it in person at 168 North Avenue or 607 Broad Street, or mail it to Courtnay Griffin or Brice Wood at the listed department addresses.
Need something notarized?
This Title VI Complaint Form doesn’t need a notary — but if you have another Rome form that does, a commissioned online notary can help.