Title VI Complaint Form

Greater Dayton RTA (GDRTA)
Office of Civil Rights

Greater Dayton RTA is committed to ensuring that no person is excluded from participation in or denied the benefits of its services on the basis of race, color or national origin, as provided by Title VI of the Civil Rights Act of 1964, as amended. Title VI complaints must be filed within 180 days from the date of the alleged discrimination.

The following information is necessary to assist us in processing your complaint. If you require any assistance in completing this form, please contact the Title VI Coordinator by calling (937) 425-8574. The completed form must be returned to Greater Dayton RTA Office of Civil Rights, Title VI Coordinator, 600 Longworth Street, Dayton OH 45402.

Person(s) 2 discriminated against (if someone other than complainant):
Which of the following best describes the reason for the alleged discrimination took place?
Have you filed a complaint with any other federal, state or local agencies?
Complainant's Signature (Name)