Title VI Complaint Form

Title VI of the Civil Rights Act of 1964, and other related laws and regulations, provide that no
person shall on the grounds of race, color, national origin, sex, age, disability, and income be
excluded from participation in, be denied the benefits of, or otherwise be subjected to
discrimination under any program or activity receiving federal funds.

The purpose of this form is to assist you in filing a complaint with CCATD’s Title VI Coordinator.
You are not required to use this form. A letter containing the same information is sufficient.
However, the information requested must be provided, whether or not this form is used. ADA
assistance is available upon request.

You may file a complaint against the CCATD. All complaints must be filed within 180 days of
the occurrence of the alleged act or a waiver requested as indicated below. You also may file a
complaint directly with the ODOT Office of Civil Rights or the FTA Office of Civil Rights.

Submit the online form here, or print out and send your completed form to the address below:

PDF Version of the Title VI Complaint form.

CCATD: Title VI Complaint Coordinator
2810 Ocean Blvd
Coos Bay, OR 97459