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TITLE VI DISCRIMINATION COMPLAINT <br />Natne <br />))!at Co Rte Post <br />BASIS OFDISCRBYIINATION <br />RACE ❑ COLOR ❑ NATIONAL ORIGIN [I SEX ❑ Diability ❑ Low-income ❑ Non-English SPeakex <br />Provide dates) andplace of alleged discriminntton <br />Describe the nature of the action, decision, or conditions of the alleged discriminnhon (Mach Extra Page. If Necessary) <br />Name ofindividuals (if Known) respens�ble fortho flctian, decision or condition of alleged discrimination <br />Pxovide aupporfing information known to complainant in support of his/her allegation <br />Tdend£ypossiblewimessrs wUomthe compleinontbeEeves car. provide factual infeanowtion about this allegation <br />State the action requested by complainant <br />75R-43 <br />