Notification of Public Rights Under Title VI
Delta Area Transit Authority
The Delta Area Transit Authority operates its programs and services without regard to race, color or national origin in accordance with Title VI of the Civil Rights Act. Any person who believes he or she has been aggrieved by any unlawful discriminatory practice under Title VI may file a complaint with Delta Area Transit Authority.
For more information on the Delta Area Transit Authority’s civil rights program, and the procedures to follow a complaint, contact 906-786-1187 or visit us at the Delta Area Transit Authority, 2901 27th Avenue N., Escanaba, MI 49829.
A complainant may file a complaint directly with the Federal Transit Administration by filing a complaint form with the Office of Civil Rights, Attention Title VI Program Coordinator, East Building, 5th Floor TCR, 1200 New Jersey Ave., SE, Washington, DC 20590.
If information is needed in another language contact 906-786-1187.
Delta Area Transit Authority
TITLE VI COMPLAINT FORM
Title VI of the 1964 Civil Rights Act requires that “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.” If you feel you have been discriminated against in transit services, please provide the following information to assist us in processing your complaint.
Please print clearly:
Name: _________________________________________________________________________
Address: _______________________________________________________________________
City, State, Zip Code: _____________________________________________________________
Telephone Number: ________________ (home) _________________ (cell) ________________(work)
Ok to Leave a Message
- Yes
- No
Are you filing this complaint on your own behalf?
- Yes
- No
*If yes to this question, please give that person’s information below.
Person discriminated against: ______________________________________________________
Address of person discriminated against: _____________________________________________
City, State, Zip Code: ____________________________________________________________
Please indicate why you believe the discrimination occurred:
- race or color
- national origin
- income
- other
What was the date of the alleged discrimination? ________________________________________
Where did the alleged discrimination take place? ________________________________________
Please describe the circumstances as you saw it: _______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Please list all witnesses’ names and phone numbers:
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Have you filed this complaint with any other Federal, State, or local agency, or with any Federal or State Court?
- yes
- no
If yes, check all that apply:
- Federal Agency________________________________________________________________
- Federal Court_________________________________________________________________
- State Court___________________________________________________________________
- State Agency__________________________________________________________________
- Local Agency__________________________________________________________________
Please provide information about a contact person at the agency/court where the complaint was filed.
Name: _________________________________________________________________________
Title: __________________________________________________________________________
Agency: ________________________________________________________________________
Address: _______________________________________________________________________
Telephone number: _______________________________________________________________
What type of corrective action would you like to see taken?
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Please attach any documents you have which support the allegation. Then date and sign this form and send to the Title VI Coordinator at:
Title VI Coordinator
Delta Area Transit Authority
2901 27th Ave N Escanaba, MI 49829
906-786-1186
906-786-0036
_________________________________ _______________ ______________________________
Signature Date Print Name