Title VI of the Civil Rights ActNotice to the Public To make AJCPT riders aware of its commitment to Title VI compliance, and their right to file a civil rights complaint, AJCPT has presented the following information, in English on its vehicles, website, ride guide, onboard bus, schedules. and social media Your Civil Rights Access Johnson County Public Transit (AJCPT) operates its programs and services without regard to race, color, or national origin, in accordance with Title VI of the Civil Rights Act and other statutes and authorities that prohibit discrimination in Federally assisted programs and activities. Any person who believes they have been aggrieved by any unlawful discriminatory practice under Title IV may file a complaint with AJCPT. For more information on AJCPT's civil rights program and the procedures to file a complaint, please contact (317) 738-5500; email [email protected] or visit our administrative office at 3500 N Morton Avenue. Franklin. IN from 9:00 am - 4:00 pm. A complaint may also be filed directly with the FTA, Office of Civil Rights, 1200 New Jersey Avenue SE, Washington DC 20590. For more information about AJCPT programs and services, visit www.gatewavarc.com. If information is needed in another language, please contact (317) 738-5523. Discrimination Complaint Procedures AJCPT has established a process for riders to file a complaint under Title VI. Any person who believes that she or he has been discriminated against on the basis of race, color, or national origin by AJCPT may file a Title IV complaint by completing and submitting the agency's Title VI Complaint available at our administrative offices or on our website www.gatewayarc.com. AJCPT will notify INDOT of all formal complaints within five business days of receiving complaint. Access Johnson County Public Transit Discrimination Complaint Form Title Vl and ADA Section I: Name: Address: Telephone (Home): Telephone (Work): Electronic Mail Address: Accessible Format Requirements? ☐ Large Print ☐ Audio Tape ☐ TDD ☐ Other Section II: Are you filing this complaint on your own behalf? ☐ Yes* ☐ No *If you answered “yes” to this question, go to Section III. If not, please supply the name and relationship of the person for whom you are complaining. Please explain why you have filed for a third party: Please confirm that you have obtained the permission of the aggrieved party if you are filing on behalf of a third party. ☐ Yes ☐ No Section III: I believe the discrimination I experienced was based on (check all that apply): ☐ Race ☐ Color ☐ National Origin ☐ Disability Date of Alleged Discrimination (Month, Day, Year): Explain as clearly as possible what happened and why you believe you were discriminated against. Describe all persons who were involved. Include the name and contact information of the person(s) who discriminated against you (if known) as well as names and contact information of any witnesses. If more space is needed, please use the back of this form. Section IV: Have you previously filed a Discrimination Complaint with this agency? ☐ Yes ☐ No If yes, please provide any reference information regarding your previous complaint. Section V: Have you filed this complaint with any other Federal, State, or local agency, or with any Federal or State court? ☐ Yes ☐ No If yes, check all that apply: ☐ Federal Agency: ☐ Federal Court: ☐ State Agency: ☐ State Court: ☐ Local Agency: Please provide information about a contact person at the agency/court where the complaint was filed. Name: Title: Agency: Address: Telephone: Section VI: Name of agency complaint is against: Name of person complaint is against: Title: Location: Telephone Number (if available): |
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