Form

Green Bay MPO - Title VI Complaint Online Submission

For paper copy, please download from website, https://www.browncountywi.gov/departments/planning-and-land-services/planning/title-vi-plan/

Complaint form submitted online or by mail will be processed according to MPO Title VI Complaint Procedure.

First Name:

Last Name:

Address:

City:

State:

Zip Code:

Email Address:

Phone Number:

Part 1: Complaint Information:

Part II: Cause of Discrimination Based On: (Check all appropriate boxes):

Part III: The Particulars Are: (Include names. dates, places, and incidents involved in the complaint:

Part IV: Remedy Sought: (State the specific remedy sought to reslove the issues.):

Part V: Date: