GHT Form VI Complaints

Title VI of the Civil Rights Act of 1964 states “No person in the United States shall, on the ground of race, color or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance.”

Please provide the following information necessary in order to process your complaint.

Assistance is available upon request. Persons with Limited English Proficiency have the right to free language translation services.

Your Name

Phone

Best time of day to contact you about this complaint: 7am-10am 10am-1pm 1pm-4pm 4pm-7pm

Your Mailing Address (Required if response is requested)

Street/PO Box

City

State

Zip

Person(s) Discriminated against (if other than Complainant)

Name

Phone Number

City

State

Zip

Discrimination because of

Date of incident resulting in descriminaton

Describe how you were discriminated against. What happened and who was responsible?

Did you file this complaint with another federal, state or local agency, or with a federal or state court? Yes No

If your answer is Yes, check each agency that a complaint was filed with

Federal Agency

Federal Court

State Agency

State Court

Local Agency

Other

Provide the contact information of the agency you also filled the complaint with.

All Above Information are Verified By Me

Find more information about the Grays Harbor Transit Title VI program online at ghtransit.com/titlevi

GHT Form VI Complaints

GHT Title VI Complaint Form

GHT Title VI Complaint Form