Civil Rights, Accessibility & Accommodation Complaints or Requests

Civil Rights, Accessibility & Accommodation Requests

Company

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Name(Required)

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email(Required)

Enter Email Confirm Email

Phone

What 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

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Report Discrimination

Review 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)

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Reasonable modification section

Review 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.

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Questions / request help

Ask 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.