Rights under title vi

Macon Area Chamber of Commerce TITLE VI COMPLAINT FORM

“No person in the United States shall, on the basis 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.”

If you feel that you have been discriminated against in the provision of transportation services, please provide the following information to assist us in processing your complaint. Should you require any assistance in completing this form or need information in alternate formats, please let us know. You may complete the online form below or download the form and return it to the address below, either in person or by mail.

Macon Area Chamber of Commerce
102 Vine Street, Macon, MO 63552

Notifying the Public of Rights under Title VI

Macon Area Chamber of Commerce posts Title VI notices on our agency’s website, in public areas of our agency, in our boardroom, and on our buses and/or paratransit vehicles.

Macon Area Chamber of Commerce operates its programs and services without regard to race, color, or national origin in accordance with Title VI of the Civil Rights Act of 1964.

To obtain additional information about your rights under Title VI, contact the Macon Area Chamber of Commerce.

If you believe you have been discriminated against based on race, color, or national origin by the Macon Area Chamber of Commerce, you may file a Title VI complaint by completing, signing, and submitting the agency’s Title VI Complaint Form.

How to file a Title VI complaint with Macon Area Chamber of Commerce:

1. To obtain a Complaint Form from the Macon Area Chamber of Commerce, contact the Macon Area Chamber of Commerce 102 Vine St Macon, MO 63552 660-385-2811.

2. In addition to the complaint process at the Macon Area Chamber of Commerce, complaints may be filed directly with the Federal Transit Administration, Office of Civil Rights, Region VII, 901 Locust Street, Suite 404, Kansas City, MO 64106

3. Complaints must be filed within 180 days following the date of the alleged discriminatory occurrence and should contain as much detailed information about the alleged discrimination as possible.

4. The form must be signed and dated and include your contact information.

If information is needed in another language, contact 660-385-2811

Download Title VI Complaint Form

ONLINE TITLE VI COMPLAINT FORM

Persons who are deaf or hard of hearing may also contact ACT through Relay Missouri Services at
(800) 735-2966 or 711 (Toll Free – TTY).

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Alternate Phone

(###)

###

####

Name of person(s) discriminated against (if someone other than complainant):

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Alternative Phone

(###)

###

####

Please check the reason(s) for which you believe you were discriminated:

Race

Color

National Origin

Date and Circumstances of Incident

Please describe the alleged discrimination incident. Provide the name and title of all individuals involved if available. Explain what happened and who you believe was responsible. You may email any written materials or other information that you believe is relevant to your complaint to director@maconmochamber.com.

Please list any witness(es) to the alleged discrimination.

If you have no witnesses, indicate "None" in the space below.

What corrective action would you like seen taken?

If you are unsure of a corrective action, please indicate "Unsure" in the space below.

Have you filed a complaint with any other federal, state or local agency/agencies/court(s)?

Yes

If so, please list the agencies in which you filed a complaint and provide their contact information:

Complainants Name

I affirm that I have read the above charge and that it is true to the best of my knowledge, information, and belief. Entering your name in the space below is considered a legal affirmation.

First Name

Last Name

Date of submission:

YYYY