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Civil Rights Policy and Complaint Form

Phone: 720-972-4123 - Contact Nutrition Services

If you believe that discrimination was a factor in an incident or action, you have the right to file a complaint.  Civil rights complaints can be directed to the Adams 12 Five Star Schools Nutrition Services Resource Manager. Please view the Civil Rights Complaint Procedure (English - Spanish). 
  • Complaints will be reviewed and forwarded to the appropriate BASE and Nutrition Supervisor.
  • Complaints can be made verbally (in person or over the phone) or in writing by submitting the Nutrition Services Civil Rights Complaint Form (English - Spanish).
  • Complaints may be filed anonymously.
  • Completion of the Civil Rights Complaint Form is not a prerequisite for filing a complaint.

For questions or to file a complaint please contact Lisa Hart at (720) 972-6140.


USDA Nondiscrimination Statement:

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/USDA-OASCR%20P-Complaint-Form-0508-0002-508-11-28-17Fax2Mail.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.