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CITY OF SANTA ANA TITLE <br />VI COMPLAINT FORM <br />Title VI of the Civil Rights Act of 1964 prohibits discrimination on the basis of race, color or <br />national origin in programs and activities receiving Federal financial assistance. Specifically, <br />Title VI provides that "no person in the United States shall, on the ground of race, color, or <br />national origin, be excluded from participation in, be denied the benefits of, or be subjected <br />to discrimination under any program or activity receiving Federal financial assistance." <br />Title VI guarantees fair treatment for all people and provides for the City of Santa Ana, to <br />identify and address, as appropriate, disproportionately high and adverse effects of its <br />programs, policies, and activities on minority and low-income populations, such as undertaking <br />reasonable steps to ensure that Limited English Proficient (LEP) persons have meaningful <br />access to the programs, services, and information the City of Santa Ana provides. <br />SECTION I <br />Name <br />Mailing Address <br />Telephone Numbers (Home) (Mobile) <br />Electronic Mail(Email)Address <br />Are there any accessible format needs? <br />Large Print <br />( ) CD/Audio Tape <br />( ) TDD <br />( ) Other <br />SECTION II <br />Are you filing this complaint on your own behalf?._Yes* _No <br />*If you answered "yes" to this question, go to Section II/ <br />If not, please supply the name and relationship of the person for who you are complaining: <br />Please explain why you have filed for a third party: <br />55C-12 <br />6 <br />