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SECTION V <br />What remedy are you seeking forth 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 ANDTODAY'S DATE ARE REQUIRED BELOW: <br />Signature Date <br />Please submit this completed form in person, or mail the form to: Jennifer Sommers, Title <br />VI - Equal Opportunity Officer, City of Santa Ana, 20 Civic Plaza, M-24, Santa Ana, CA 92701. <br />Please make a copy for your records. <br />November 2017 <br />55C-814 <br />