Grievance Form

Policy Statement

The City of Redmond assures that no person shall on the grounds of race, color, national origin, or gender, as provided by Title VI of the Civil Rights Act of 1964 and the Civil Rights Restoration Act of 1987, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity, regardless of whether or not they are federally funded.

Furthermore, the City of Redmond assures that no person shall, on the grounds of age, ethnicity, disability, sexual orientation, income or limited English proficiency be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity.
For questions regarding the City’s Title VI Program please contact the Title VI Coordinator at 425-556-2466,

Filing a Grievance

Any person who believes his or her Title VI protection has been violated may file a complaint with the City of Redmond by contacting the Title VI Coordinator or filling out the following form.

If you are unable to provide a written statement, a verbal complaint may be made to the Title VI Coordinator, who will interview you to prepare a written version of the complaint, then submit to you for signature. The complaint must be filed with 180 days of the date of the alleged violation, and the form must be completely filled out to enable the Title VI Coordinator to assist you properly. If the form is deemed incomplete, the Title VI Coordinator will request additional information.

When a complaint is received, the Title VI Coordinator will provide written acknowledgment to the complainant within ten (10) days, inform the complainant of action taken or proposed action to process the complaint, and advise the complainant of other avenues of redress available via state and federal agencies. The Title VI Coordinator will also notify the Washington State Department of Transportation within ten (10) days of receipt of the complaint.

Online Grievance Form

Complainant’s Name (required)

Address (required)         

State   Zip Code  (required) 

Phone Number (required)  

Alternate Phone Number (optional) 

Was the person discriminated against you or another person? 
Me       Another person 

The following is required if “Another person” was checked above.

  • Other Person’s Name
  • Other Person’s Address
  • Other Person’s City  
    State   Zip Code      

Which of the following best describes the reason you believe the discrimination took place?  


National Origin



Income Status

On what date did the alleged discrimination take place?

In your own words, describe the alleged discrimination. Explain what happened and whom you believe was responsible.      

Contact information for witnesses or individuals with relevant knowledge. Please include names, addresses and phone numbers if available.     

Have you filed this complaint with any other federal, state or local agency or court?   Yes   No

The following is required if “Yes” was checked above.

Check each box that applies
 Federal Agency

 State Agency

 Local Agency

 Federal Court

 State Court


Security Measure

Title VI Coordinator

Angie Venturato