Get Title Vi Discrimination Complaint Form Samtrans Is Committed To ...

Filing a discrimination complaint is an important step towards ensuring equal treatment. This guide will assist you in completing the Title VI Discrimination Complaint Form provided by SamTrans, ensuring your voice is heard and your concerns are addressed.

Follow the steps to effectively complete the complaint form.

1. Press the ‘Get Form’ button to access the complaint form and open it in your document editor.
2. Begin by providing your contact information in Section 1. Fill in your name, address, city, state, zip code, and phone numbers. Ensure to highlight if any number is for a TDD or TTY. Include your email address for further communication.
3. In Section 2, specify if you are filing the complaint on your own behalf or for another person. If filing for another, provide the name and relationship of the individual. Explain your reason for filing on their behalf and confirm you have their permission.
4. Move to Section 3 where you will detail the discrimination complaint. Indicate the reason for your belief of discrimination (race, color, or national origin). Include the details about the aggrieved party and describe the incident, including the date, time, location, and any identifiable individuals involved.
5. Proceed to Section 4 to disclose any previous complaints or lawsuits related to this issue. Indicate if you have filed a complaint with other agencies or courts and provide their contact details if applicable.
6. In Section 5, sign the form to attest to the truthfulness of your statements. You may also attach any supportive documents that may strengthen your complaint.
7. After completing the form, save your changes. You may choose to download, print, or share the filled-out form as needed.

Complete your complaint form online today to ensure your rights are protected.