Dear Ms. Bobblehead: Please allow this letter to serve as my complaint of discrimination against the U.S. Army. Title VI Discrimination Complaint Form.Please fill out this form completely, complaints should be filed with 180 days of the alleged discrimination. This form may be used to file a complaint with the County of Dallas based on violations of Title VI of the Civil Rights Act of 1964. Jane files a complaint with HUD because she suspects that the leasing officer does not want to rent to her because she is Muslim. A description of why you believe you were discriminated against, such as because of your race, ethnicity, sex, age, disability, pregnancy, or other reasons. We have received a formal complaint alleging that you have engaged in one or more discriminatory housing practices under the Federal Fir Housing Law. A Charge of Discrimination can be completed through our EEOC Public Portal after you submit an online inquiry and we interview you. Languages: this sample accommodation letter is available in English and Spanish. Read this form andthe instructions on reversecarefully before completing.