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Title VI Complaint Form
This form may be used to file a complaint with the City of Battle Creek based on violations of Title VI of the Civil Rights Act of 1964. You are not required to use this form; a letter that provides the same information may be submitted to file your complaint. Complaints should be filed within 180 days of the alleged discrimination. If you could not reasonably be expected to know the act was discriminatory within 180 day period, you have 60 days after you became aware to file your complaint.
If you need assistance completing this form, please contact Ted Dearing by phone at (269)966-3378 or via e-mail at firstname.lastname@example.org
Date(s) of alleged discrimination:
The City of Battle Creek prohibits retaliation or intimidation against anyone because that individual has either taken action or participated in action to secure rights protected by policies of the City. Please inform Ted Dearing listed above if you feel you were intimidated or experience perceived retaliation to filing this complaint.
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