Dupage County Title Vi Complaint Form - Dupage County Department Of Community Services


DuPage County Title VI Complaint Form
Description: Title VI of the 1964 Civil Rights Act requires that “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 off, or be subjected to discrimination under any program or activity
receiving federal financial assistance.” If you feel you have been discriminated against in transit
services, please provide the following information in order to assist us in processing your
complaint and send it to:
Mary A. Keating
DuPage County Department of Community Services
421 N. County Farm Road
Wheaton, IL 60187
Please print clearly or type:
Name: ________________________________________________________________________
Address: ______________________________________________________________________
City, State, Zip Code: ____________________________________________________________
Telephone/Cellular Number: ______________________________________________________
Name of person allegedly discriminated against: ______________________________________
Address of person alleged discriminated against: ______________________________________
City, State, Zip Code of person allegedly discriminated against:
Please check off why you believe discrimination occurred (check all that apply):
____National Origin
____Other (explain):________________________________________________________
What was the date of the alleged discrimination: _________________________________
Where did the alleged discrimination take place:__________________________________


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