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Title VI Complaint Form

    Section I

    Name*

    Address

    Telephone (Home/Cell)

    () -

    Telephone (Work)

    () -

    E-mail*

    Do you require an accessible format?

     

    Section II

    Are you filing this complaint on your own behalf?

     

    If you answered "yes" to this question, go to Section III.
    If not, please supply the name and relationship of the person for whom you are filing:

     

    Name

    Relationship

     

    Have you obtained permission from this person?

     

    Please explain why you are filing for this person:

     

    Section III

     

    I believe the discrimination I experienced was based on (check all that apply):

    RaceColorNational Origin

     

    Date of alleged discrimination

     

    Explain as clearly as possible what happened and why you believe you were discriminated against. Describe all persons who were involved. Include the name and contact information of the person(s) who discriminated against you (if known) as well as names and contact information of any witnesses.

     

    Section IV

    Have you ever filed an ADA complaint with MST?

    Contact Name

    Telephone number

    () -

     

    Section V

    Have you filed this complaint with any other federal, state, or local agency, or with any other federal or state court?

     

    If yes, please check all that apply:

    Federal Agency:
    State Agency:
    Local Agency:
    Federal Court:
    State Court:
    Local Court:

     

    Please provide contact information for the person you spoke to at the above agency:

     

    Name

    Title

    Agency

    Address

    Telephone

    () -

     

     

    Title VI Complaint Process

    In compliance with U.S. Department of Transportation Title VI regulations (49 CFR Part 21), Monterey-Salinas Transit (MST) operates without regard to race, color, or national origin. Any person who believes he or she has been discriminated against by MST on the basis of race, color, or national origin may file a Title VI complaint.

    A Title VI complaint form can be downloaded at mst.org or by calling 888-678-2871 (TTY/TDD 831-393-8911). If the complainant is unable to write a complaint, a representative may file on his or her behalf, or MST staff will provide assistance. Complaints must be filed within 180 calendar days of the alleged incident.

    1. MST will contact the complainant within 10 business days of receipt of complaint. Any requested information must be received by MST within 5 days of request*.
    2. MST will begin the investigation within 15 business days of receipt of complaint if the alleged discrimination is found to be a violation of Title VI regulations.
    3. MST will complete the investigation within 60 calendar days of receipt of complaint. If additional time is needed for the investigation, the complainant will be notified. A written investigation report will be prepared, including a summary description of the incident, investigative findings, and recommended corrective action.
    4. A closing letter will be provided to the complainant. The complainant will have 5 business days from receipt of the closing letter to file an appeal. If no appeal is filed, the complaint will be closed.
    5. MST will forward a copy of the investigation report to the appropriate federal agency, if required.

    *MST will process and investigate all complaints that meet the requirements of Title VI discrimination. If the complainant fails to provide required information within the required timeframe, the complaint may be closed.

    Complaints may also be filed directly with the Federal Transit Administration, Office of Civil Rights, East Building, 5th Floor – TCR, 1200 New Jersey Ave., SE, Washington, DC 20590 or online at http://www.fta.dot.gov/civilrights/12884.html.

    interpreterIf information is needed in another language, contact 888-678-2871
    Si necesita información en otro idioma, llame a 888-678-2871