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Civil Rights Complaint Form

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Please correct the field(s) marked in red below:

If you wish to submit this complaint via a paper form, you may contact Roxane Walton, City of Kissimmee, 101 Church Street, Kissimmee, Florida 34741 or by email at rwalton@kissimmee.org
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Contact Information
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Contact Information
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Incident Information
Incident Information
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Discrimination on the basis of (please check):
Discrimination on the basis of (please check):
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Please briefly explain the incident that triggered a Title VI violation, including the nature of the event, who was involved and any other details necessary for an investigation. (NOTE: You may use the other side of this paper and/or attach a separate document.) 
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