Open a New Ticket

Please fill in the form below to open a new ticket.

Contact Information Please provide complete information to enable METRO staff to investigate and/or respond to your issue. If you do not wish to provide an email, fill the required email field with your phone number followed by @na Ex.8315557777@na If you do not wish to provide contact information or wish to have a customer service representative open a ticket for you, contact our Customer Service Call Center at (831) 425-8600
Preferred method of contact? *
Email Address *
Full Name *
Phone Number * Ext:
Help Topic *
*
Title VI Discrimination Complaint This form is meant to be used to report violations of our Title VI Discrimination Policy. For any other reporting, select the appropriate Help topic. Before filling out the form, please read our Title VI Discrimination Policy
Complainant's Name or Authorized 3rd Party (if different from "Full Name" entered above)
Phone Number * Ext:
Street Address: *
City: *
State: *
Zip: *
Date and Time of Violation * (PST)
Date of Complaint * (PST)
Violation Location *
Bus Number (if known)
Bus Route
Bus Stop ID (4 digit code)
Please indicate discrimination in this complaint beacuse of any of the following, which are prohibitited by Title VI of the Civil Rights Act of 1964 (select all that apply) *
Please indicate discrimination in this complaint because of any of the following, which are strictly prohibited by Santa Cruz METRO (select all that apply) *
Other (if applicable)
If known, please provide the name(s) of the METRO Directors, employees and/or agents who allegedly discriminated against you, including their job titles
Identify what METRO service, program or activity resulted in discrimination against you: *
Explain as clearly as possible what happened, how you feel you were discriminated against and who was involved. Describe how you were treated differently? (For Subject and Message fields below, enter either "N/A" or provide any additional inform *
Identify individuals by name, address and phone nuber that have information relating to the violation:
Additional Comments

Open a New Ticket

Contact Information

Title VI Discrimination Complaint

Loading ...