Title VI Complaint Form | Valley Metro

Title VI Complaint Form

Any person who believes that he or she has been discriminated against by Valley Metro or any of its service providers, and believes the discrimination was based upon race, color or national origin may file a formal complaint with Valley Metro Customer Service.

Please provide the following information to process your complaint. Alternative formats and languages are available upon request. You can reach Customer Service at (602) 253-5000 / TTY: (602) 251-2039, or email at csr@valleymetro.org.

Complete the form below.

* indicates required field


Section 1: Customer Information
Enter Full Name
Format: (123) 456-7890
Section 2: Incident Data
Date of incident *
Time of incident *
:
Service type *
Section 3
What was the discrimination based on? (check all that apply): *

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

Section 4
Have you filed this complaint with the Federal Transit Administration? *
Please provide information about a contact person at the Federal Transit Administration where the complaint was filed.
Section 5
Have you previously filed a Title VI complaint with this agency? *
Section 6
Files must be less than 2 MB.
Allowed file types: gif, jpg, jpeg, png, txt, pdf, doc, docx.
Enter legal name. This will be considered your signature.