Bureau County, IL · Bureau County
Title VI Complaint Form
Bureau County residents may use this form to report alleged discrimination based on race, color, or national origin in a county program, service, or activity.
At a glance
- Issued by
- City of Bureau County · Bureau County, Bureau County, Illinois
- Notarization
- Not required: file this form without a notary.
- Official source
- bureaucounty-il.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
Use this form to file a complaint with Bureau County about alleged discrimination based on race, color, or national origin in a program, service, or activity receiving federal financial assistance. It asks for the complainant’s contact details, information about the alleged discrimination and any prior complaints, and a signature and date. You may attach relevant written materials or other information.
Who needs it
A person reporting alleged discrimination to Bureau County, or someone filing on behalf of an affected person with that person’s permission, may use this form.
How to submit it
Please submit the completed form by mail to the County Administrator, Bureau County, at 700 South Main Street, Princeton, IL 61356.
About notarization
This form is signed and dated without a notary; no notarized or sworn attachment is identified, so the signer simply signs and dates it.
How to submit this form
- 1
Download the Form
Download the Title VI Complaint Form.
- 2
Complete the Form
Provide your contact information, explain the alleged discrimination, and answer the questions about prior complaints and filing for another person.
- 3
Gather Attachments
Attach any written materials or other information you think is relevant to your complaint.
- 4
Submit to the County
Submit the signed and dated form to the County Administrator, Bureau County, at 700 South Main Street, Princeton, IL 61356.
Frequently asked questions
- What is the Title VI Complaint Form for?
- It allows someone to file a complaint with Bureau County about alleged discrimination based on race, color, or national origin in a program, service, or activity receiving federal financial assistance.
- Who can file this complaint?
- You may file on your own behalf or for another person. If filing for someone else, the form asks for your relationship, why you are filing, and confirmation that you have the affected person’s permission.
- Do I need a notary for the Title VI Complaint Form?
- No. This form is signed and dated without a notary; no notarized or sworn attachment is identified, so the signer simply signs and dates it.
- How do I submit the Title VI Complaint Form?
- Submit the completed form to the County Administrator, Bureau County, at 700 South Main Street, Princeton, IL 61356.