City of Victoria Form Center

2. First Name | Nombre*

   Please enter your legal first name or the first name as it appears on the Title VI Complaint Form

3. Last Name | Apellido*

   Please enter your legal last name or the last name as it appears on the Title VI Complaint form.

5. Email Address | Correo Electrónico*

   Enter your email address

7. Form | Formulario*

   Please upload your completed and signed Title VI Complaint form here.

Leave This Blank:


9. 1. Receive an email copy of this form.
10. Email address

    This field is not part of the form submission.

11. Submit Submit and Print

* indicates a required field