Title VI Complaint FormHCS2022-12-14T10:43:43-05:00
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