Luna Pier, MI · Monroe County
Title VI Complaint Form
Residents may use this form to submit a complaint to the City of Luna Pier about alleged discrimination in a city program, service, or activity.
What this form is
This form may be used to file a Title VI complaint with the City of Luna Pier about alleged discrimination in a program, service, or activity receiving federal assistance. It asks for contact details, information about the alleged discrimination and the agency or department involved, and a signature and date. Complaints should be filed within 180 days, subject to the form’s stated exception.
Who needs it
Anyone wishing to file a Title VI complaint with the City of Luna Pier may use this form or submit a letter with the same information.
How to submit it
Return the completed form to Crystal Manley, Deputy Clerk, at 4357 Buckeye Street, Luna Pier, MI 48157, or by fax at 734-848-2714 or email to [email protected].
About notarization
This complaint form is signed and dated without a notary; it mentions no notarized or sworn attachment, so the signer just signs and dates it.
How to submit this form
- 1
Download The Form
Download the City of Luna Pier Title VI Complaint Form.
- 2
Complete The Form
Provide your contact details, information about the alleged discrimination and department, and sign and date the form.
- 3
Gather Supporting Materials
Attach additional sheets if needed and provide a copy of written material pertaining to your case.
- 4
Submit To The City
Return the completed form to the Deputy Clerk by mail, fax, or email using the details printed on the form.
Frequently asked questions
- What is the Title VI Complaint Form for?
- Use it to file a complaint with the City of Luna Pier about alleged discrimination in a program, service, or activity receiving federal assistance.
- Do I need a notary for the Title VI Complaint Form?
- No. The form asks for a signature and date, but does not require a notary or mention a notarized or sworn attachment.
- How do I submit the Title VI Complaint Form?
- Return it to the Deputy Clerk at the address on the form, or send it by fax or email using the contact details provided on the form.
- When should I file a Title VI complaint?
- The form says complaints should be filed within 180 days of the alleged discrimination. If you could not reasonably have known it was discriminatory within that period, it allows 60 days after you became aware.