Title VI Complaint Form

Title VI of the 1964 Civil Rights Act requires that “No person in the United States shall, on the grounds of race, color, and national origin be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance.”

The following information is necessary to assist us in processing your complaint.  If you need assistance in completing the form, please contact the Title VI Coordinator:

Title VI Coordinator 
City of Riverside
3900 Main Street, 2nd Floor Riverside, CA 92522
Ph: (951) 351-6162 / Fax: (951) 826-6320
TDD: TTY: 7-1-1 / Email: [email protected]

Person discriminated against (if other than complainant)

Which of the following best describes the reason you believe the discrimination took place?

List any others who may have knowledge of this event

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.