Title VI & Civil Rights Complaint Form - Rhode Island

Contact Information
Home Address:
Discrimination Complaint
Name of Staff Person that you Believe Discriminated Against You
Other Statutes
Explain as briefly and clearly as possible what happened and how you were discriminated against. Indicate who was involved. Be sure to include how other persons were treated differently than you. Also attach any written material pertaining to your case such as any persons (witnesses, fellow employees, supervisors, or others), if known, whom we may contact for additional information to support or clarify your complaint. (Please be sure to provide contact information, and use additional sheets if necessary.)
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