Civil Rights Complaint Record

E 1312.30

Civil Rights Complaint Record 


Child Nutrition Services
Teaching and Learning Support
801 West 10th Street, Suite 200
P.O. Box 110500
Juneau, Alaska    99811-0500
(907) 465-8708

 
 

Name of Sponsor:
 
Name of Complainant:
 
Site of Complaint:
 
Reported by:
 
Nature of Complaint: (race, color, national origin, age, sex, disability)

 

 

 
Date reported to sponsor:
 
Date reported to state:
 
Date reported to FNS:
 
CNS staff documenting report:
 

Please fill out this form and send to either of the following agencies:

 

Program Administrator, Child Nutrition Services
Teaching and Learning Support
Alaska Department of Education and Early Development
801 West 10th Street, Suite 200
Juneau Alaska 99811-0500

Director, USDA, Office of Civil Rights
Room 326-W
Whitten Building       
1400 Independence Avenue, SW
Washington, DC 20250-9410
 
 

USDA is an equal opportunity provider and employer.

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