Civil Rights, Accessibility & Accommodation Requests CommentsThis field is for validation purposes and should be left unchanged.Name(Required) First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzechiaDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTürkiyeTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Email(Required) Enter Email Confirm Email PhoneWhat do you need help with?(Required)This form covers complaints and requests under Title VI of the Civil Rights Act of 1964, ADA Title II, and reasonable modification provisions. Report discrimination Request a reasonable modification / accommodation Ask a question or request assistance This field is hidden when viewing the formReport DiscriminationReview RFTA’s ADA Policy and Procedures.I believe that I have been discriminated against on the basis of:(Required)Choose any that apply Race Color National Origin Name/Position (Title) of person(s) who allegedly discriminated against you:Location of Incident:Date/Time of Incident:Briefly explain the situation/incident:(Required)Consent(Required)I agree that: I have read, understood and accepted the terms and procedures for tracking and investigating ADA complaints and I affirm that the information above is true to the best of my knowledge. I agreeThis field is hidden when viewing the formReasonable modification sectionReview RFTA’s Reasonable Modification Policy.Modification or Accommodation Request(Required)Why, based on a disability, is the modification necessary?Provide Description(Required)Provide a description of your limitation(s) and how it is affected by RFTA’s policies and / or procedures.Consent(Required)I agree that: I have read, understood and accepted the terms and procedures for reasonable modification requests and I affirm that the information above is true to the best of my knowledge. I agreeThis field is hidden when viewing the formQuestions / request helpAsk questions or request assistance(Required)Not sure what steps to take? Start here and our Civil Rights Compliance Officer, Customer Service representative, or Paratransit Coordinator will follow up with you. This site is protected by reCAPTCHA. Complaints may also be filed directly with: Colorado Department of Transportation Title VI & ADA Program Manager 2829 W. Howard Place Denver, CO 80204 CDOT_Accessibility@state.co.us Voice Mail: 303-512-4220 File a Discrimination Complaint with CDOT
