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Explain as clearly as possible what happened and why you believe discrimination occurred. Describe all persons who were involved. Include the name and contact information of any witnesses*:
Your IP address and time will be captured upon form submission. This information will be emailed to Curtis Roberts & saved for future reference. If you have questions you can contact Curtis by phone at: 435-713-6963 Please inform him that this is a Title VI complaint when you call. You can also email him at email@example.com You can also send him a written letter
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You can also pickup (at above address) or print a copy of this form and mail it to the above address.