Discrimination Complaint Form

The North Central Texas Council of Governments (NCTCOG) is a voluntary association of, by, and for local governments, established to assist in regional planning. As a recipient of federal financial assistance and under Title VI of the Civil Rights Act of 1964 and related statutes, NCTCOG ensures that no person shall, on the grounds of race, religion, color, national origin, sex, age or disability be excluded from participation in, be denied the benefits of, or otherwise be subjected to discrimination under any agency programs or activities. These prohibitions extend from the North Central Texas Council of Governments, as a direct recipient of federal financial assistance, to its sub-recipients (e.g., contractors, consultants, local governments, colleges, universities, etc.). All NCTCOG programs are subject to Title VI requirements.

NCTCOG is required to implement measures to ensure that persons with limited English proficiency have meaningful access to the services, benefits and information of all its programs and activities under Executive Order 13166. Upon request, assistance will be provided if you are limited English proficient. Complaints may be filed using an alternative format if you are unable to complete the written form.

The filing date is the day you complete and submit this complaint form. Your complaint must be filed no later than 180 calendar days from the most recent date of the alleged act of discrimination. The complaint form and consent/release form must be dated and signed for acceptance. You have 30 calendar days to respond to any written request for information. Failure to do so will result in the closure of the complaint.

If you have any questions or need additional information, please call 817-695-9121 or e-mail Monte Mercer.

Who do you believe discriminated against you?
When did the alleged act(s) of discrimination occur?
Please list all applicable dates in MM/DD/YYYY format
Where did the alleged act(s) of discrimination occur?
Indicate the basis of your grievance of discrimination.
If an advisor will be assisting you in the complaint process, please provide their name and contact information.
In order to address your allegations, this complaint form must be signed and dated and you will need to provide consent to disclose your name, if needed, in the course of our investigation by completing the section that follows. If you are filing a complaint of discrimination on behalf of another person, our office will also need this person's consent.
I certify that to the best of my knowledge the information I have provided is accurate and the events and circumstances are as I have described them. I also understand that if I will be assisted by an advisor, my acknowledgement below authorizes the named individual to receive copies of relevant correspondence regarding the complaint and to accompany me during the investigation.