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Brentwood, TN, 37027

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Discrimination Complaint

Please correct the field(s) marked in red below:

The John P. Holt Brentwood Library Title VI Discrimination Complaint Form

Provide the following information to assist staff in processing your complaint.

1
Complainant
 *
Complainant
2
Person discriminated against (if someone other than the complainant)
 *
Person discriminated against (if someone other than the complainant)
3
Which of the following best describes the reason you believe the discrimination took place? 

Was it because of your:


Which of the following best describes the reason you believe the discrimination took place? Was it because of your:
4
What date did the alleged discrimination take place?
5
Describe the alleged discrimination.
 *
6
Have you tried to resolve this complaint through other methods?
Have you tried to resolve this complaint through other methods?
7
Have you filed a complaint with any other federal, state, or local agency, or with any federal or state court with regards to this matter?
Have you filed a complaint with any other federal, state, or local agency, or with any federal or state court with regards to this matter?
8
If yes, check all that apply.
If yes, check all that apply.
9
Do you intend to file this complaint with another agency?
Do you intend to file this complaint with another agency?
10
Has a complaint been filed previously about this matter with the Library?
Has a complaint been filed previously about this matter with the Library?
11
Have you filed any other complaints regarding the Library?
Have you filed any other complaints regarding the Library?
12
By clicking below, you certify that the above information is accurate. Additional written materials or other information that is relevant to your complaint can be sent to askus@brentwoodtn.gov.
 *
  1. To receive a copy of your submission, please fill out your email address below and submit.