Laserfiche WebLink
Appendix A <br /> City of Sunny Isles Beach <br /> Title VI Complaint of Discrimination <br /> Complainant Name: Address: <br /> Phone Number: <br /> E-mail Address: <br /> Please list the names, addresses and phone numbers of any witnesses: <br /> Location of Incident: Date of Incident: <br /> Discrimination € Race € Color € Nation Origin € Sex € Age € Handicap/Disability <br /> Because of: <br /> € Income Status € Retaliation € Other <br /> Please explain how, why, when and where you believe you were discriminated against. Include as <br /> much background information as possible about the alleged acts of discrimination. Additional pages <br /> may be attached if needed. <br /> Complainant Signature: Date of Signature: <br /> Note: Alternate means of filing complaint, such as personal interviews or a tape recording of the <br /> complaint, will be made available for persons with disabilities upon request. <br /> City of Sunny Isles Beach <br /> Title VI Program Plan <br />