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SECTION V <br />What remedy are you seeking for the alleged discrimination? <br />How did you learn that you could file this complaint? <br />SECTION VI <br />You may attach any written materials or other information that you think is relevant to <br />your complaint. <br />YOUR SIGNATURE AND TODAY'S DATE ARE REQUIRED BELOW: <br />Signature Date <br />Please submit this completed form in person, or mail the form to: Anita Queen, Title VI - <br />Equal Opportunity Officer, City of Santa Ana, 20 Civic Plaza, M -24, 5thfloor, Santa Ana, CA <br />92701. <br />Please make a copy for your records. <br />JULY 2012 <br />55B101-11 <br />