[Iowa DOT] 107009. Title VI Complaint Form

Please provide the following information necessary in order to process your complaint. A formal complaint must be filed within 180 days of the occurrence of the alleged discriminatory act. Assistance is available upon request. Please contact Iowa DOT Civil Rights Bureau (CRB) at (515) 239-1304 or Civil.Rights@iowadot.us

Title 42 U.S.C. Section 2000d

Title VI of the Civil Rights Act of 1964 states "No person in the United States shall, on the ground 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."

Complete this form and return to:

Iowa Department of Transportation

Civil Rights Bureau (CRB)

800 Lincoln Way

Ames, IA 50010

Please sign and date. The complaint will not be accepted if it has not been signed. You may attach any written materials or other supporting information you think is relevant to your complaint.

Print Document

Create Your Signature

Sign Now!

Please provide accurate information below to ensure the delivery of the signed copies of the document.