Title VI Complaint Form

Please contact Bismarck Parks and Recreation District at 701-222-6455, by emailing bisparks@bisparks.org, or in person at 400 E. Front Ave., Bismarck, ND 58504 for assistance with this form.

Title VI Complaint Form

Complete this form to submit a Title VI complaint to the Park District of the City of Bismarck, ND.

This field is for validation purposes and should be left unchanged.

Your Contact Information

Name(Required)

First Last

Address(Required)

Street Address City State ZIP Code

Phone

Incident Information

Name of Person(s) That Discriminated Against You

Position of Person (if known)

Date of Incident(Required)

Location of Incident(Required)

Address of Incident (if known)

Street Address City State ZIP Code

Reason for Discrimination (check all that apply)(Required)

Specify other reason for discrimination, if it applies.

Explain as briefly and clearly as possible what happened and how you were discriminated against. Indicate who was involved. Be sure to include how other persons were treated differently than you.(Required)

Attach any written material pertaining to your case by uploading files.

Drop files here or

Accepted file types: pdf, jpg, png, gif, doc, docx, Max. file size: 16 MB.

Signature(Required)

Date(Required)

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