Rome, GA · Floyd County
Title VI Notice and Complaint Form (Spanish Version)
This Spanish-language form lets a person who believes they experienced discrimination submit a Title VI complaint to the Rome Transit Department or Rome and Floyd County planning organization.
What this form is
Use this form to report discrimination that you believe occurred in a program or activity covered by Title VI. It asks for your contact details, the reason for the complaint, what happened, and information about the agency or person involved. It also asks whether you have filed the complaint elsewhere and requires your signature and date; you may attach relevant written material.
Who needs it
A person who believes they experienced discrimination covered by Title VI may use this form to submit a complaint.
How to submit it
Deliver the completed form in person or by mail to Courtnay Griffin at 168 North Avenue, Rome, Georgia 30162, or Brice Wood at 607 Broad Street, Rome, Georgia 30161. The form also lists P.O. Box 1433, Rome, Georgia 30161, as a mailing address.
About notarization
This document is signed and dated without a notary; the form requires the complainant’s signature and date, and mentions no sworn or notarized attachment.
How to submit this form
- 1
Download The Form
Download the Spanish-language Title VI Notice and Complaint Form PDF.
- 2
Complete The Form
Provide your contact information, describe what happened, and answer the questions about prior complaints.
- 3
Gather Attachments
Attach any written material or other information you think is relevant to your complaint.
- 4
Sign And Submit
Sign and date the form, then deliver it in person or mail it to one of the addresses listed on the form.
Frequently asked questions
- Do I need a notary for the Title VI complaint form?
- No. The form requires your signature and date, but no notary. You may attach relevant written material; the form does not say that attachments must be notarized.
- How do I submit the Title VI complaint form?
- Deliver it in person or mail it to Courtnay Griffin at 168 North Avenue, Rome, Georgia 30162, or Brice Wood at 607 Broad Street, Rome, Georgia 30161. The form also lists P.O. Box 1433 as a mailing address.
- What information does the form ask for?
- It asks for your contact details, what happened and why you believe it was discrimination, information about the agency or person involved, and whether you filed the complaint elsewhere.
- Can I include supporting documents?
- Yes. The form says you may attach written material or other information that you think is relevant to your complaint.
Need something notarized?
This Title VI Notice and Complaint Form (Spanish Version) doesn’t need a notary — but if you have another Rome form that does, a commissioned online notary can help.