Title VI Complaint | Muncie Indiana Transit System

Civil Rights Complaint Form

Please describe your complaint. You should include specific details such as names, dates, times, route numbers, witnesses, and any other information that would assist us in our investigation of your allegations. Please also provide any other documentation that is relevant to this complaint, including any related correspondence from Muncie Indiana Transit System.

Section I

Section I: I believe that I have been (or someone else has been discriminated against on the basis of:

Race / Color / National Origin
Disability
Not Applicable

I believe that Muncie Indiana Transit System has failed to comply with the following program requirements

Disadvanted Business Enterprise
Equal Employment Opportunity
Title VI
Americans With Disabilities (ADA)
Not Applicable

Section II

Name:*

Street Address:*

City*

State

Zip Code

Home Phone Number

Cell Phone Number

E-Mail Address

Accessible format requirements

Large Print
Not Applicable
Other

Section III

Are you filling this complaint on your own behalf?*

Yes
No

[If you answered "yes" to this question, go to Section IV.]

If not, please supply the name and the relationship of the person for whom you are complaining:

Person Complaint relationship

Please explain why you have filed for a third party:

why third party

Please confirm that you have obtained the permission of the aggrieved part if you are filing on behalf of a third party:

Yes
No

Section IV

What was the nature of your complaint?

Have you previously filed a civil rights complaint with MITS?

Yes
No

Section V

Please provide a description of your current complaint below.

Consent*

The information above is correct to the best of my knowledge

Name*

First Last

Date*

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