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Title VI Complaint Form

  1. The City of DeKalb / Voluntary Action Center of DeKalb County (VAC) are committed to ensuring that no person is excluded from participation in or denied the benefits of its services on the basis of race, color or national origin, as provided by Title VI of the Civil Rights Act of 1964, as amended. Title VI complaints must be filed within 180 days from the date of the alleged discrimination.

  2. The following information is necessary to assist us in processing your complaint. If you require any assistance in completing this form, please contact the City of DeKalb Civil Rights Officer at (815) 748-2367. The completed form must be returned to The City of DeKalb, Civil Rights Officer, 200 S. 4th St, DeKalb, IL 60115.

  3. Person discriminated against (if someone other than complainant):

  4. Which of the following best describes the reason for the alleged discrimination that took place?*

  5. Have you filed a complaint with any other federal, state or local agencies?

  6. I affirm that I have read the above charge and that it is true to the best of my knowledge, information and belief.

  7. Complaints may also be filed with the Federal Transit Administration’s Office of Civil Rights, no later than 180 days after the date of the alleged discrimination:

  8. 200 West Adams Street, Suite 320,

    Chicago, Illinois 60606

  9. Phone: (312) 353-3770

  10. The investigative officer shall maintain a log of Title VI complaints received from this process which log shall include the date the complaint was filed; a summary of the allegations; the status of the complaint; and actions taken by either the City of DeKalb or VAC in response to the complaint. Should the City of DeKalb or VAC receive a Title VI complaint in the form of a formal charge or lawsuit, the agency’s attorney(s) shall be responsible for the investigation and maintaining a log as described herein.

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  12. This field is not part of the form submission.