Title VI Complaint Form

In accordance with the requirements of Title VI of the Civil Rights Act of 1964, it is unlawful for airport operators and their lessees, tenants, concessionaires, and contractors to discriminate against any person because of race, color, national origin, sex, creed, or disability in public services and employment opportunities.

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Complainant Name*

Address

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

Phone

Email*

Date of Incident*

Time of Incident*

Location of Incident*

Name(s) of People Involved

Airport-Affiliated Party Involved*

Which of the following best describes the reason you believe that discrimination took place?*

Nature of Incident*

Proposed Remedy*

Complaint already filed with the U.S. Department of Justice, another government agency, or in court?*

Yes

If Yes, provide contact information of that agency or court and the date the complaint was filed:*

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

Max. file size: 50 MB.

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Date

Name

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