Do I need a notary for the Title VI complaint form?

No. Sign and date the form; it does not require a notary or mention a sworn attachment.

How do I submit the Title VI complaint form?

Submit it in person or by mail to Courtnay Griffin at 168 North Avenue, Rome, or Brice Wood at 607 Broad Street, Rome. The form also lists P.O. Box 1433, Rome, as a mailing address.

What information does the form ask for?

It asks for your contact details, information about the alleged discrimination and people involved, and whether you filed complaints elsewhere. You must sign and date it.

Can I include supporting materials?

Yes. The form says you may attach written materials or other information that you think is relevant to your complaint.

Rome, GA · Floyd County

No notary required

Title VI Notice and Complaint Form (English Version)

This form lets people report alleged discrimination by Rome Transit Department or the Metropolitan Planning Organization of Rome and Floyd County.

What this form is

The document explains Title VI rights and provides a form to report alleged discrimination by the Rome Transit Department or the Metropolitan Planning Organization of Rome and Floyd County. Complainants provide contact details, describe the alleged discrimination, identify involved people or agencies, and sign and date the form; they may attach relevant materials.

Who needs it

People who believe they experienced unlawful discrimination under Title VI by the Rome Transit Department or the Metropolitan Planning Organization can use this form.

How to submit it

Submit the signed 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 30162 as a mailing address.

About notarization

This complaint form is signed and dated without a notary; the document mentions no sworn attachment or notarized related step.

How to submit this form

1
Download the Form
Download the English Title VI Notice and Complaint Form.
2
Complete the Form
Provide your contact details and describe the alleged discrimination, including people involved and any prior complaints.
3
Gather Attachments
Attach any written materials or other information you think is relevant to your complaint.
4
Sign and Submit
Sign and date the form, then submit it in person or by mail to a listed contact.

Frequently asked questions

Do I need a notary for the Title VI complaint form?: No. Sign and date the form; it does not require a notary or mention a sworn attachment.
How do I submit the Title VI complaint form?: Submit it in person or by mail to Courtnay Griffin at 168 North Avenue, Rome, or Brice Wood at 607 Broad Street, Rome. The form also lists P.O. Box 1433, Rome, as a mailing address.
What information does the form ask for?: It asks for your contact details, information about the alleged discrimination and people involved, and whether you filed complaints elsewhere. You must sign and date it.
Can I include supporting materials?: Yes. The form says you may attach written materials or other information that you think is relevant to your complaint.

Need something notarized?

This Title VI Notice and Complaint Form (English Version) doesn’t need a notary — but if you have another Rome form that does, a commissioned online notary can help.