WIOA Title I Complaint Form HomeWIOA Title I Complaint Form Name (First, Middle Initial, and Last)(Required)Home Phone(Required)Business PhoneEmail Address(Required)State Agency you believe has discriminated or retaliated Agency(Required)Apple CommissionArts CommissionAthletic CommissionBarley CommissionBean CommissionBoard of Tax AppealsBoise State UniversityCode CommissionCommission for the Blind & Visually ImpairedCommission of Pardons and ParoleCommission on AgingCommission on Hispanic AffairsCorrectional IndustriesCouncil for Deaf and Hard of HearingCouncil on Developmental DisabilitiesCouncil on Domestic ViolenceDairy CommissionDepartment of AdministrationDepartment of AgricultureDepartment of CorrectionDepartment of EducationDepartment of Environmental QualityDepartment of FinanceDepartment of Fish and GameDepartment of Health and WelfareDepartment of InsuranceDepartment of LandsDepartment of Parks and RecreationDepartment of Water ResourcesDivision of Financial ManagementDivision of Human ResourcesDivision of MilitaryDivision of Occupational & Professional LicensesDivision of Veterans ServicesDivision of Vocational RehabilitationEducational Services for the Deaf and the BlindEndowment Fund Investment BoardForest Products CommissionGrape Growers & Wine Producers CommissionHouse of RepresentativesIdaho Board of Scaling PracticesIdaho Career and Technical EducationIdaho Children’s Trust FundIdaho Commission for LibrariesIdaho Department of CommerceIdaho Department of Juvenile CorrectionsIdaho Department of LaborIdaho Department of TransportationIdaho Industrial CommissionIdaho Public Safety CommunicationsIdaho Public TelevisionIdaho Rural PartnershipIdaho Soil and Water Conservation CommissionIdaho State Historical SocietyIdaho State Liquor DivisionIdaho State PoliceIdaho State UniversityIdaho Supreme CourtIdaho Tax CommissionIdaho Workforce Development CouncilInformation Technology ServicesJudicialLava Hot Springs FoundationLegislative Services OfficeLewis-Clark State CollegeLottery CommissionNorthwest Power and Conservation CouncilOffice of Drug PolicyOffice of Energy and Mineral ResourcesOffice of Performance EvaluationsOffice of Secretary of StateOffice of Species ConservationOffice of the Attorney GeneralOffice of the GovernorOffice of the Lieutenant GovernorOffice of the State Board of EducationOffice of the State ControllerOffice of the State TreasurerPea and Lentil CommissionPotato CommissionPublic Employee Retirement System of IdahoPublic Health District 1Public Health District 2Public Health District 3Public Health District 4Public Health District 5Public Health District 6Public Health District 7Public Utilities CommissionRangeland Resource CommissionSenateState Appellate Public DefenderState Independent Living CouncilState Insurance FundState Public Defense CommissionSTEMSuperintendent of Public InstructionUniversity of IdahoWheat CommissionDepartment (if known)Agency LocationComplaint Information Is the complaint in connection to your participation in a WIOA program?YesNoI don't knowHave you contacted the agency regarding this complaint? Yes No If yes, date of contactWho did you speak with?Basis for complaintRaceColorReligionSexNational OriginAgeDisabilityPolitical AffiliationBeliefCitizenshipParticipation in WIOA Title I Program or ActivityMultipleOtherDate of Incident(Required)Where did the incident occur?Describe the details of the incident:(Required)What is the desired outcome of this complaint:Witness Information If applicable.Name (First, Middle Initial, and Last)Home PhoneBusiness PhoneEmail AddressMay we contact this witness? Yes No Electronic Signature I CERTIFY the information furnished is true and accurate to the best of my knowledge. I AUTHORIZE the disclosure of this information as needed for the proper investigation and enforcement of my complaint. I UNDERSTAND my identity will be kept confidential to the maximum extent possible, consistent with applicable law and a fair determination of my complaint. I also understand it is against the law for my employer to discharge, intimidate, retaliate, coerce or discriminate against me for filing this complaint.Signed(Required)
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