Jacksonville, TX · Cherokee County
Title VI Complaint Form
This form lets a person submit a complaint describing alleged discrimination and related details to the City of Jacksonville.
What this form is
The Title VI Complaint Form records the complainant’s contact information, the basis and dates of alleged discrimination, and a description of what happened. It also asks about alleged retaliation, people who may provide information, related complaints, any discussion with a representative, and the remedy sought. The form says an unsigned complaint cannot be accepted and allows additional pages, information, or photographs.
Who needs it
A person submitting a complaint about alleged discrimination or retaliation can use this form to provide details and request a remedy.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This document is signed without a notary; the complainant signs and dates the form, and no notarized or sworn attachment is mentioned.
How to submit this form
- 1
Download The Form
Download the Title VI Complaint Form PDF.
- 2
Complete The Form
Fill in your contact information and describe the alleged discrimination, any retaliation, and the remedy you seek.
- 3
Gather Supporting Information
Add any supporting pages, information, or photographs you believe may assist with an investigation.
- 4
Sign And Submit
Sign and date the form; the document says an unsigned complaint cannot be accepted. Check the city website for submission details.
Frequently asked questions
- What information does the Title VI Complaint Form request?
- It asks for contact details, the basis and dates of alleged discrimination, a description of events, possible witnesses, related complaints, and the remedy sought.
- Do I need a notary for the Title VI Complaint Form?
- No. The form asks the complainant to sign and date it, and does not mention a notarized or sworn attachment.
- How do I submit the Title VI Complaint Form?
- The form says to submit the completed form but leaves the recipient blank. Check the city website for current contact details.
- Can I include supporting information with my complaint?
- Yes. The form allows additional pages and asks you to provide any additional information or photographs that may assist with an investigation.
Need something notarized?
This Title VI Complaint Form doesn’t need a notary — but Texas residents can notarize other documents online with a commissioned online notary.