Ontario County, NY · Ontario County
Title VI Complaint Form
Individuals who believe they experienced discrimination in Ontario County programs or services use this form to submit a Title VI complaint.
At a glance
- Issued by
- City of Ontario County · Ontario County, Ontario County, New York
- Notarization
- Not required: file this form without a notary.
- Official source
- ontariocountyny.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
This form lets individuals report alleged discrimination in Ontario County programs and services based on race, color, national origin, sex, age, disability, low income, or limited English proficiency. The form says complaints must be filed within 60 days of the alleged occurrence. It asks for complainant and incident details, the requested corrective action, information about any related complaints, and the agency or person involved.
Who needs it
Anyone who believes they experienced discrimination in Ontario County programs or services may use this form to file a complaint.
How to submit it
Mail or deliver the completed form to the Ontario County Title VI Coordinator/Compliance Officer, 3019 County Complex Drive, Canandaigua, NY 14424, or email it to [email protected].
About notarization
This form is signed and dated without a notary; it lists no notarized or sworn attachment, so the signer just signs and dates it.
How to submit this form
- 1
Download the Form
Download the Ontario County Title VI Complaint Form.
- 2
Complete the Form
Provide your contact details, describe the alleged discrimination, and answer the questions about related 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 mail, deliver, or email it to the Title VI Coordinator/Compliance Officer using the details on the form.
Frequently asked questions
- Do I need a notary for the Title VI Complaint Form?
- No. The form requires your signature and date but has no notary block. It lists no notarized or sworn attachment, so the signer just signs and dates it.
- How do I submit the Title VI Complaint Form?
- Mail or deliver it to the Ontario County Title VI Coordinator/Compliance Officer at 3019 County Complex Drive, Canandaigua, NY 14424, or email it to [email protected].
- What information does the complaint form ask for?
- It asks for your contact details, information about the alleged discrimination and people involved, the corrective action you want, and details of any related complaint filed elsewhere.
- When does the form say to file a complaint?
- The form says a complaint must be filed within 60 days of the alleged occurrence.