ADA and Title VI Complaint Form

The Americans with Disabilities Act (ADA) prohibits discrimination on the basis of disability in employment, State and local government, public accommodations, commercial facilities, transportation, and telecommunications. To be protected by the ADA, one must have a disability or have a relationship or association with an individual with a disability.


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.”


A complainant may file a complaint directly with the Federal Transit Administration by filing a complaint 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 you feel you have been discriminated against, a complaint may be filed with UCP by completing the following information in order to assist us in processing your complaint:

 

 

Section I

 
 
 
 
 
 
 
 
 
 

 

Section II

 
 

 

Section III

 
 

Click to select a date or enter as MM/DD/YYYY

 
mm/dd/yyyy
 

If more space is needed, please upload document(s) at the bottom of this form.

 
 

 

Section IV

 
 

 

Section V

 
 

 

Section VI

 
 
 
 
 

** Indicates is specific to Title VI of the Civil Rights Act of 1964

 

You may attach any written materials or other information that you think is relevant to your complaint.

Drop your files here
 
 

Enter your name and today's date below to sign this complaint form.

 
 
 
mm/dd/yyyy