Fircrest, WA · Pierce County
Title VI Complaint Form
Residents can use this form to report alleged discrimination involving a City of Fircrest program or activity and provide information for the city to process the complaint.
What this form is
The form lets a person report alleged discrimination and provide their contact details, an account of what happened, incident details, and information about any complaint filed with another agency. The form states that complaints must be filed within 180 days of the alleged discrimination. It also asks the signer to affirm that the information is true to the best of their knowledge.
Who needs it
A person reporting alleged discrimination involving a City of Fircrest program or activity can complete and submit this complaint form.
How to submit it
Submit the completed form to the City of Fircrest, Attn: Title VI Coordinator, 115 Ramsdell Street, Fircrest, WA 98466. The form lists 253-564-8901 as a contact number.
About notarization
This document does not require a notary; the signer affirms under penalty of perjury that the information is true and signs and dates the form.
How to submit this form
- 1
Download The Form
Download the City of Fircrest Title VI Complaint Form PDF.
- 2
Complete The Form
Provide your contact details, describe the alleged discrimination, and include the incident date, time, and location.
- 3
Gather Attachments
Attach additional materials as needed and provide details about any complaint filed with another agency.
- 4
Sign And Submit
Sign and date the form, then send it 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 does not require notarization. It asks you to affirm under penalty of perjury that the information is true to the best of your knowledge, then sign and date it.
- How do I submit the Title VI Complaint Form?
- Send the completed form to the City of Fircrest, Attn: Title VI Coordinator, 115 Ramsdell Street, Fircrest, WA 98466. The form lists 253-564-8901 as a contact number.
- What information does the complaint form ask for?
- It requests your contact information, a description of the alleged discrimination and the facts, incident date, time and location, and details about any complaint filed with another agency.
- When must I file a complaint?
- The form states that complaints must be filed within 180 days of the date of the alleged discrimination.
Need something notarized?
This Title VI Complaint Form doesn’t need a notary — but if you have another Fircrest form that does, a commissioned online notary can help.