Do I need a notary for the Title VI complaint form?

No. The form asks you to sign and date it, but has no notary block or notarized attachment.

What information does the complaint form ask for?

It asks for your contact information, the alleged discriminator's name, the City department or grantee, an incident description, the basis of the complaint, your signature, and the date.

When must I file a written complaint?

The document says a written complaint of alleged discrimination must be filed within 180 days of the occurrence.

Castle Rock, WA · Cowlitz County

No notary required

Title VI Program & Equal Employment Opportunity Complaint Form

This form lets people report alleged discrimination by a City employee or another person or entity involved in a Castle Rock program.

What this form is

Use this form to report alleged discrimination or exclusion from City-provided activities or services based on a listed protected group. The document asks complainants to provide contact details, identify the alleged discriminator and City department or grantee, describe the incident, select a basis, and sign and date the complaint. It says a written complaint must be filed within 180 days of the occurrence.

Who needs it

People who believe they experienced discrimination or exclusion in a City of Castle Rock program or service can use this form to file a complaint.

How to submit it

Return the written complaint to City of Castle Rock Title VI Coordinator Carie Cuttonaro at 141 A Street SW / PO Box 370, Castle Rock, WA 98611.

About notarization

This document is signed and dated without a notary; the form lists no notarized or sworn attachment or related step.

How to submit this form

1
Download The Form
Download the Title VI Program & Equal Employment Opportunity Complaint Form.
2
Complete The Form
Provide your contact details, identify the alleged discriminator and department or grantee, describe the incident, and select a basis.
3
Add Any Extra Pages
Attach additional pages if needed to describe the incident.
4
Sign And Date
Sign and date the complaint form.
5
Return The Complaint
Return the written complaint to the Title VI Coordinator at the address listed on the form.

Frequently asked questions

Do I need a notary for the Title VI complaint form?: No. The form asks you to sign and date it, but has no notary block or notarized attachment.
How do I submit the Title VI complaint form?: Return the written complaint to Title VI Coordinator Carie Cuttonaro at 141 A Street SW / PO Box 370, Castle Rock, WA 98611.
What information does the complaint form ask for?: It asks for your contact information, the alleged discriminator's name, the City department or grantee, an incident description, the basis of the complaint, your signature, and the date.
When must I file a written complaint?: The document says a written complaint of alleged discrimination must be filed within 180 days of the occurrence.

Need something notarized?

This Title VI Program & Equal Employment Opportunity Complaint Form doesn’t need a notary — but if you have another Castle Rock form that does, a commissioned online notary can help.