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Recreational Boating Safety Grant Program

How members of the public may file a complaint of discrimination under Title VI, Title IX, Rehabilitation Act and Age Discrimination Act.

NOTE: Please do not use these directions for Employment-related discrimination complaints -- Coast Guard Employees and applicants must contact a Full Time Coast Guard Civil Rights Service Provider for employment-related claims of discrimination.

Recreational Boating Safety Grant Complaint

The Civil Rights Directorate and Civil Liberties, Department of Homeland Security, ensures that all federally-assisted and federally-conducted programs or activities of the Department comply with the provisions of Title VI of the Civil Rights Act of 1964, as amended; Title IX of the Education Amendments of 1972, as amended; Section 504 of the Rehabilitation Act of 1973, as amended; the Age Discrimination Act of 1975, as amended; and related Executive Orders.  While not required, please provide the information listed below to better enable the Department to address complaints of discrimination based upon race, color, national origin, disability, gender and age that involve a recreational safe boating program that receives grant funding through the Coast Guard. 

You may send the information via e-mail to civil.liberties@dhs.gov or print a copy and mail it to: Department of Homeland Security, 245 Murray Lane, SW, Building 410, Mail Stop #0800, Review & Compliance Unit, Civil Rights and Civil Liberties, Washington, DC 20528 or fax it to: 202-401-4708.  You may also call Toll Free: 1-866-644-8360 or Toll Free TTY: 1-866-644-83611 for additional information. In addition, you may also seek assistance from the Coast Guard Civil Rights Directorate by writing to: Commandant (CG-00H), External Program Manager, 2100 2nd St., S.W., STOP 7000, Washington, DC 20593-7000.

1.       
 
 
 
                          
 

2.   Person discriminated against (if someone other than complainant)
       
       
       
     
                                

3.  What is the name and location of the State or non-profit organization that you believe discriminated against you?

      
      
      
    

4.  Which of the following best describes the reason you believe the discrimination took place?  Was it because of your:

          
   

5.    

6.  
     

7.  Do you have any witnesses to verify your allegations?    Yes  No
      If yes,
       
       
       
          

8.   Have you tried to resolve this complaint through the internal grievance procedure at the accused State or non-profit organization?
      Yes    No
      
      
      

       Name and title of the person who is handling the grievance procedure.
        
        
           

9.    Have you filed this complaint with any other federal, State or local agency, educational institution or non-profit organization; or with any federal or state court?
       Yes   No

If yes, check all that apply:




 10.  Please provide information about a contact person at the agency/court where the
complaint was filed.
        
        
        
           

11.   Do you intend to file this complaint with another agency?
       Yes    No

       If yes, when and where do you plan to file the complaint?
        
        
        
        
      

12.  Has this complaint been filed with this agency before?
       Yes   No

       If yes, when?   

13.  Have you filed any other complaints with this agency?
       Yes    No

       If yes, when and against who were they filed?
        
          
        
        
      

         
     

     
     

14.  Are you represented by an attorney with regard to anything related to this      matter?
       Yes   No

       If yes, please fill in the following:
      
        
        
           


 

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Last Modified 10/9/2014