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Title VI Complaint Form
Use this form to file a Title VI complaint with the City of Santa Barbara. Title VI prohibits discrimination based on race, color, national origin, sex, age, or disability in any program or activity receiving federal funding.
Full Name
*
Mailing Address
*
Phone Number
*
Email
Basis of Complaint
Race
Color
National Origin
Sex
Disability
Other
If "Other" is checked above, please describe in the area below.
Date of Incident
Location of Incident
*
Agency/Department Involved
*
Please describe the alleged discrimination.
*
Witnesses (Optional)
Has this complaint been filed with another agency?
Yes
No
If yes, which agency(s)?
disregard this