Form LGL 001 Virginia

Title VI Complaint Allegation

The Department of Motor Vehicles (DMV) rejects discrimination in all of its programs and activities. Title VI of the 1964 Civil Rights Act and related non-discrimination authorities prohibit discrimination on the basis of race, color, national origin, sex, disability, age, low income, or limited English proficiency. Use this form to record any allegation or allegations of discrimination. The information you provide allows us to process your complaint.

This document is a Title VI complaint form issued by the Department of Motor Vehicles (DMV) of Virginia, allowing individuals to report alleged discrimination based on race, color, national origin, sex, disability, age, low income, or limited English proficiency. The form includes instructions for completion and submission, as well as contact information for the Title VI Program Coordinator. The individual completing the form is required to provide their full name, address, telephone number, and relationship to the person discriminated against, if applicable. They must also indicate which protected category they believe was violated and provide details of the alleged discrimination, including date and responsible party. The form asks whether the complaint has been filed elsewhere and requests information about any previous filing.