Title VI Complaint Form

Appendix C

TITLE VI COMPLAINT FORM

Pine Bluff Transit (PBT)

     Pine Bluff Transit 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 1964 Civil Rights Act, 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.  Please email any documents you have which support the allegation to transit@cityofpinebluff-ar.gov.  Then date and sign this form and send to the Title VI Coordinator at the address below.  If you require any assistance in completing this form, pleases contact Pine Bluff Transit by calling (870) 543-5130.  The completed form must be returned to:

Pine Bluff Transit

2300 East Harding Street

Pine Bluff, AR 71601

Please print clearly: