Title VI Complaint Form

Lutheran SeniorLife assures that no person shall, on the grounds of race, color, or national origin, as provided by Title VI of the Civil Rights Act of 1964, and the Civil Rights Restoration Act of 1987 (P.L. 100-259) be excluded from participating in, or be denied the benefits of, or be otherwise subject to discrimination under any program, or activity.

Furthermore, Lutheran SeniorLife further assures that every effort will be made to ensure nondiscrimination in all of its federally funded program activities.

Any person believing they have been discriminated against based on race, color, or national origin should fill out the form below. If you have other information that may be relevant to your complaint, please download the Title VI Complaint Form and mail the completed form to the Corporate Compliance Officer.

You can direct mail the form to: Lutheran SeniorLife; Corporate Compliance Officer; 191 Scharberry Lane Mars, PA 16046.

Finally, you may also call the Corporate Compliance Hotline directly at 1-866-910-2654 to submit your complaint.

(If other than complainant): List all names:
Please describe the alleged discrimination incident. Explain what happened, how you were discriminated against, and all persons who were involved. Include the name of the person(s) who discriminated against you (if known), as well as the names and contact information of any witnesses.
Please include contact name(s), agency, street address and phone number.