The Arc of Indian River County
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Address:
Telephone (Home):
Telephone (Work):
Electronic Mail Address:

Section II:
Are you filing this complaint on your own behalf?
Yes*
No

*If you answered "yes" to this question, go to Section III.

If not, please supply the name and relationship of the person for whom you are complaining:
 
Please explain why you have filed for a third party:
 
Please confirm that you have obtained the permission of the aggrieved party if you are filing on behalf of a third party.
Yes
No

Section III:
I believe the discrimination I experienced was based on (check all that apply):
[ ] Race                                 [ ] Color                                              [ ] National Origin                        [ ] Age
[ ] Disability                         [ ] Family or Religious Status            [ ] Other (explain) ____________________________
Date of Alleged Discrimination (Month, Day, Year):    __________
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 information of any witnesses. If more space is needed, please use the back of this form.
________________________________________________________________________
________________________________________________________________________

Section IV
Have you previously filed a Title VI complaint with this agency?
Yes
No

Section V
Have you filed this complaint with any other Federal, State, or local agency, or with any Federal or State court?
[ ] Yes                                         [ ] No
If yes, check all that apply:
[ ] Federal Agency:                                                          
[ ] Federal Court                                                                              [ ] State Agency                                 
[ ] State Court                                                                                 [ ] Local Agency                                 

Please provide information about a contact person at the agency/court where the complaint was filed.     
Name:
Title:
Agency:
Address:
Telephone:
Section VI

Name of agency complaint is against:
Contact person:
Title:
Telephone number:
 
You may attach any written materials or other information that you think is relevant to your complaint.
Signature and date required below
 
                                             _________________________________  ________________________
  Signature                                                                                                                    Date
 
Please submit this form in person at the address below, or mail this form to:
The Arc of Indian River County, Inc.
1375 16th Avenue, Vero Beach, FL 32960
 
If information is needed in another language, contact 772-562-6854.

Services

Supported Employment

Parents
Page

The Arc of Indian River County
1375 16th Ave
Vero Beach, FL 32960
(772) 562-6854
​​The Arc of IRC, Inc is a 501(c) (3) corporation.  We are proud to be a funded partner of United Way.
Picture
  • Home
    • Who We Are
    • Board
    • Our Team
    • Employment
    • TRAINING >
      • Core Competencies
      • Supported Living Coach
      • Zero Tolerance
    • News >
      • Fragile Group Home
      • More news
  • Programs and Services
    • Residental Services >
      • Group Homes
    • Adult Day Training (ADT)
    • Transportation >
      • Title VI Public Notice
      • ADA Grievance Process
      • ARC Complaint Form
      • Title VI Complaint Procedure
      • Title VI Complaint Form >
        • ADA Espanol
      • Form Espanol
    • Behavior Services >
      • Why Behaviors Occur
      • Functionality of Behaviors
    • Supported Employment >
      • Individual Looking for a Job
      • Business Needing to Hire
    • Special Events >
      • Wheels for Charity
      • 6th Annual Tom Danaher Memorial Golf Classic
      • Joey Travolta Film Camp
      • Ocean Grill Night
      • Job-A-Palooza
      • Events Calendar >
        • Aktion Club
        • Coffee House
        • Youth Outreach
        • ADT 2022 Calendar
      • Pareidolia Brewery Festive~Ale
    • SURF Transition Program >
      • SURF Schedule
    • Parents Page >
      • Transition
  • Donate
    • Monthly Giving
    • Planned Giving >
      • WILLS Program
      • Planned Gift Types >
        • Types of Gifts or Donations
    • Shop >
      • Fresh Fruit
      • Amazon Smile
    • Volunteer
  • Contact Us
  • News