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Title VI Complaint Form

Thank you for filling out this Title VI Complaint form. This form provides us with information we can use to help us serve you. It is not a formal complaint. Once we receive your completed questionnaire, we will review it and then contact you for more information.

To avoid delays in processing, please submit only one complaint form to SOCR (either by mail, online, or in person) regarding the same matter.


First Name: Last Name:
Middle Initial:
Street Address:
City: State:
Zip Code: County:
Home Phone: ( ) -
Work Phone: ( ) -
Cell Phone: ( ) -
Which telephone number should we use to contact you? 
Email Address:

How did you hear about SOCR?  
Do you require language interpretation?  
Do you require sign language interpretation?  
Who can we contact if we are unable to reach you?
Name:
Daytime Phone: ( ) -
Relationship:

Name of person/s whom you believe discriminated against you:
When did this occur (please select a date):
Where did this occur:
What happened to you? How do you feel you were discriminated against? (1,000 characters max)
Have you tried to resolve the issue through a grievance process, due process hearing, or some other method?  
Have you filed the same complaint with anyone else?  
If yes, please provide date:


Accommodations for people with disabilities provided upon request.
810 Third Avenue, Suite 750, Seattle, WA 98104
Telephone: (206) 684-4500, TTY: (206) 684-4503, Fax (206) 684-0332


The Seattle Office for Civil Rights (SOCR) is responsible for civil rights compliance and monitoring of Title VI of the Civil Rights Act of 1964. The City of Seattle (City) assures that no person shall on the grounds of race, color, sex, age, disability or national origin, as provided by Title VI of the Civil Rights Act of 1964, and the Civil Rights Restoration Act of 1987 (P.L. 100.259) be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity. The City further assures every effort will be made to ensure nondiscrimination in all of its programs activities, whether those programs and activities are federally funded or not.

In the complaint investigation process, we analyze the complainant's allegations for possible Title VI and related deficiencies. If deficiencies are identified they are presented to the respondent and assistance is offered to correct the inadequacies within a predetermined timeframe. SOCR may also refer the case to Washington Department of Transportation Civil Rights Office.