Get Fl Title Vi Complaint Form - Lake County_dsa

Filing a complaint under Title VI is an important step in addressing discrimination experienced by individuals in transit services. This guide will provide you with detailed instructions on how to complete the FL Title VI Complaint Form - Lake County_DSA online, ensuring an efficient and clear submission process.

Follow the steps to successfully complete the FL Title VI Complaint Form online.

1. Press the ‘Get Form’ button to access the FL Title VI Complaint Form. This will allow you to open the form in the designated online editor.
2. In Section I, provide your personal information. Fill in your name, address, and both home and work telephone numbers. If applicable, indicate your requirements for accessible formats, such as large print or TDD.
3. In Section II, specify if you are filing the complaint on your own behalf. If you choose 'no', provide the name and relationship of the individual you are representing. Confirm that you have permission from this person to file the complaint.
4. In Section III, indicate the basis of the discrimination experienced by checking all that apply, such as race or national origin. Enter the date of the alleged incident and provide details about the location and specifics of the incident.
5. Describe the discriminatory incident in detail, naming individuals involved, and providing their contact information if available. Ensure to include any witnesses' names and their information as well.
6. Section IV asks if you have previously filed a Title VI complaint with this agency. Indicate 'yes' or 'no' and provide the date and case number if applicable.
7. In Section V, indicate whether you have filed a complaint with any other agency or court. If so, provide the relevant information and case/reference numbers.
8. Section VI requires you to name the agency you are filing the complaint against, along with a contact person's name, title, and phone number from that agency.
9. Finally, confirm the accuracy of your information by signing the form and dating it. After review, proceed to submit the completed form either in person or via mail as detailed in the instructions.

Complete your FL Title VI Complaint Form online today to ensure your concerns are officially recorded and addressed.