Rome, GA · Floyd County
Title VI Complaint Form (Spanish)
This Spanish-language form lets people who believe they experienced unlawful discrimination file a Title VI complaint with Rome’s Transit Department.
What this form is
Use this Spanish-language form to report discrimination that you believe occurred in a Rome or Floyd County program or activity. It asks for your contact details, the basis and description of the alleged discrimination, prior complaints, the agency involved, and the complained-about agency’s contact information. Sign and date the form, and submit it in person or by mail to one of the listed contacts.
Who needs it
A person who believes they experienced discrimination under Title VI may use this form to file a complaint with the listed agencies.
How to submit it
Deliver the form in person to Courtnay Griffin at 168 North Avenue or Brice Wood at 607 Broad Street, Rome, or mail it to P.O. Box 1433, Rome, Georgia 30161.
About notarization
This complaint form is signed and dated without a notary; the document identifies no sworn or notarized attachment.
How to submit this form
- 1
Download the Form
Download the Spanish-language Title VI Complaint Form.
- 2
Complete the Complaint
Provide the requested contact details and describe what happened and why you believe you were discriminated against.
- 3
Gather Supporting Materials
Attach any written materials or other information you believe is relevant to your complaint.
- 4
Sign and Submit
Sign and date the form, then deliver it in person to a listed contact or mail it to the address provided.
Frequently asked questions
- Do I need a notary for the Title VI Complaint Form?
- No. Sign and date the form; it does not identify a sworn or notarized attachment.
- How do I submit the Title VI Complaint Form?
- Deliver it in person to a listed contact at 168 North Avenue or 607 Broad Street in Rome, or mail it to P.O. Box 1433, Rome, Georgia 30161.
- What information does the complaint form ask for?
- It asks for your contact information, details about the alleged discrimination, whether you filed prior complaints, and information about the agency and contact person involved.
- Can I include supporting information?
- Yes. The form says you may attach written materials or other information you believe is relevant to your complaint.
Need something notarized?
This Title VI Complaint Form (Spanish) doesn’t need a notary — but if you have another Rome form that does, a commissioned online notary can help.