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File a Title VI Complaint

Any individual, group of individuals or entity that believes they have been discriminated against on the basis of race, color, or national origin by the Wyoming Independent Living may file a Title VI complaint by completing and submitting the agency’s Title VI Complaint Form (fill out below or download and send to WIL.)

If you wish to file a complaint against Wyoming Independent Living, please use our internal complaint form.

All information contained in this form remains confidential.

If you are unable to fill out the form below, you may also download and submit a print version of the complaint form below.

Downloads

Title VI Complaint Form.pdf
Title VI Plan.pdf

File a Title VI Complaint

Contact Information
Contact Information
What is your relationship to the person for whom you are filing?
Complaint Details
I believe the discrimination I experienced was based on
Explain as clearly as possible what happened and why you believe you were discriminated against. Describe all persons who were involved. Include the name and contact information of the person(s) who discriminated against you (if known) as well as names and contact
Section IV
Have you previously filed a Civil Rights related complaint with this agency?
Section V
Have you filed this complaint with any other Federal, State, or local agency, or with any Federal or State Court
Check all that apply