Mukilteo School District Child Nutrition
Civil Rights Complaint Procedure and Form

1. If you have/receive a Civil Rights complaint, please report it to the Nutrition Services Department as soon as possible
2. Complaints of discrimination must be filed within 180 days of the alleged discrimination.
3. Complaints may be submitted to Mukilteo School District Nutrition Services over the phone at 425-356-1212, emailed to mukilteonutritionservices@mukilteo.wednet.edu or mailed to “Nutrition Services” 8925 Airport Rd, Everett, WA 98204. Complaint forms are available on the Nutrition Services website and/or can be requested through the Nutrition Services department.
4. Complaints of discrimination may be written or verbal. Use of a form is not required for a person filing a complaint. If a person is unwilling, unable, or not inclined to put the complaint in writing, the person taking the complaint shall do so. 
5.  Complaints of discrimination should contain as much as possible of the following information:

a. Name, address, e-mail address, and telephone number or other means of contacting the complainant.
b. The specific location and name of the entity providing the benefits.
c. A description of a specific action that caused the complainant to believe that discrimination was a factor.
d. Basis on which the complainant feels that discrimination occurred (race, color, national origin, sex, age, disability, or reprisal or retaliation for prior civil rights activity).
e. Name and titles, if known, and addresses of persons who may have knowledge of the discriminatory action.
f. The date(s) the alleged discriminatory actions occurred or the duration of such action.

In accordance with federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, this institution is prohibited from discriminating on the basis of race, color, national origin, sex (including gender identity and sexual orientation), disability, age, or reprisal or retaliation for prior civil rights activity.

Program information may be made available in languages other than English. Persons with disabilities who require alternative means of communication to obtain program information (e.g., Braille, large print, audiotape, American Sign Language), should contact the responsible state or local agency that administers the program or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339.

To file a program discrimination complaint, a Complainant should complete a Form AD-3027, USDA Program Discrimination Complaint Form which can be obtained online at: https://www.usda.gov/sites/default/files/documents/ad-3027.pdf, from any USDA office, by calling (866) 632-9992, or by writing a letter addressed to USDA. The letter must contain the complainant’s name, address, telephone number, and a written description of the alleged discriminatory action in sufficient detail to inform the Assistant Secretary for Civil Rights (ASCR) about the nature and date of an alleged civil rights violation. The completed AD-3027 form or letter must be submitted to USDA by:

1. mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410; or

2. fax: (833) 256-1665 or (202) 690-7442; or

3. email: Program.Intake@usda.gov

This institution is an equal opportunity provider.

Si necesita esta información en otro idioma, llame al 425-356-1212
Якщо вам потрібна ця інформація іншою мовою, зателефонуйте за номером 425-356-1212