Mason, MI · Ingham County
Title VI Complaint Form
This form lets a person report suspected discrimination involving a City of Mason program or activity to the city for investigation.
What this form is
Use this form to report suspected discrimination by the City of Mason or its employees, agents, contractors, subcontractors, or subrecipients of federal and state funds. The complaint must be in writing, signed, and filed within 180 days of the alleged discrimination or related date specified in the policy. It asks for contact details, discrimination type, relevant dates, people involved, complaint facts, and the remedy sought.
Who needs it
A person who believes they were excluded from or denied benefits or services of a City of Mason program or activity because of discrimination may file this complaint.
How to submit it
The form says complaints may be filed with the City of Mason, MDOT, FHWA, or U.S. DOT. Send a written, signed complaint to City of Mason, 201 West Ash Street, Mason, MI 48854-0370.
About notarization
This complaint form is signed and dated without a notary; the form requires no notarized or sworn attachment.
How to submit this form
- 1
Download The Form
Download the City of Mason Title VI Complaint Form.
- 2
Complete The Form
Provide contact information, the type and dates of discrimination, details about the people involved, the complaint facts, and the remedy sought.
- 3
Sign And Date
Certify the information and sign and date the complaint; no notary is required.
- 4
Submit The Complaint
Send the written complaint to the City of Mason at 201 West Ash Street, Mason, MI 48854-0370.
Frequently asked questions
- What is the Title VI Complaint Form used for?
- Use it to report suspected discrimination involving a City of Mason program or activity, including conduct by city employees, agents, contractors, subcontractors, or subrecipients.
- Who can file a Title VI complaint?
- A person who believes they were excluded from or denied benefits or services of a city program or activity because of discrimination may file a complaint.
- Do I need a notary for the Title VI Complaint Form?
- No. The form requires the complainant or authorized representative to sign and date it; it does not require a notary or a notarized attachment.
- How do I submit the Title VI Complaint Form?
- Submit a written, signed complaint to the City of Mason at 201 West Ash Street, Mason, MI 48854-0370. The document also lists MDOT, FHWA, and U.S. DOT as complaint filing options.