ADA Complaint Form

Discrimination Complaint Form

Step 1 of 2

Please provide the following information necessary in order to process your complaint. Assistance is available upon request. Upon completion this form will be emailed to info@tulsatransit.org, TULSA TRANSIT, Civil Rights Officer, 510. S Rockford Avenue, Tulsa, OK 74120

Complainant's Name(Required)

Address(Required)

Street Address City State ZIP Code

Telephone No. (Home)(Required)

Telephone No. (Work)

Person filling out form (if other than complainant)

Address

Street Address City State ZIP Code

Date of the incident(Required)

Form(Required)

ADA Rights

Title VI Rights

Rights Violated(Required)

Race

Color

National Origin

Describe how your rights were violated. What happened and who was responsible?(Required)

What Tulsa Transit employee(s) was involved in the incident? i.e. Driver, Call Center, Security Officer

Where did the incident take place? Please provide location, bus number, driver's name, time, etc.(Required)

Discrimination Complaint Form

Person filling out form (if other than complainant)

By typing your name and date, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement.