Title VI Complaint Form

Title VI Complaint Form

Title VI of the Civil Rights Act of 1964 states "No person in the United States shall, on the ground of race, color or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance." Please provide the following information necessary in order to process your complaint. Should you require any assistance in completing this form, please let us know. You may also print and mail this form to us at: Corporate Compliance Officer VNA at HCS P.O. Box 564 Keene, NH 03431