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Step One

Instructions: If you would like to submit a Title VI complaint to The Wave Transit System (WTS), please fill out the form below. It will be sent to our Senior Planner and DBE Liaison Officer, James Rich, and our Manager of Transportation, David Dixon. For questions, or a full copy of The Wave’s Title VI Policy and Complaint Procedures, please call 251.344.6600, Ext: 228.
Name (Complainant)
Email Address
Address
City
State
Zip Code
Phone Number
Fax Number
1. If applicable, name of person(s) who allegedly discriminated against you:
2. Location and position of person(s) if known:
3. Date of incident:
4. Discrimination because of:
1. Race/Color
2. National Origin
3. Creed/Religion
4. Disability
1. Sex (includes sexual harassment)
2. Sexual Orientation
3. Marital Status
4. Age
1. Vietnam Era Veteran
2. Disabled Veteran
3. Retaliation
5. Explain as briefly and clearly as possible what happened and how you believe you were discriminated against. Indicate who was involved. Be sure to include how you feel other persons were treated differently than you. Also, send any written material pertaining to your case to 110 Beauregard St, Ste 104, Mobile, AL 36602, addressed to Senior Planner & DBE Liaison Officer, James Rich:
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6. Why do you believe these events occured?
7. What other information do you think is relevant to the investigation
8. How can this / these issue(s) be resolved to your satisfaction?
9. Please list below any person(s) we may contact for additional information to support or clarify your complaint (witnesses):
Witness 1 (If applicable)
First Name
Last Name
Address
City
State
Zip Code
Phone Number
Email Address
Witness 2 (If apllicable)
First Name
Last Name
Address
City
State
Zip Code
Phone Number
Email Address
Witness 3 (If applicable)
First Name
Last Name
Address
City
State
Zip Code
Phone Number
Email Address
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10. Have you filed this complaint with any other federal, state, or local agency; or with any federal or state court?
1. Yes
2. No
If yes, check all that apply
1. Federal Agency
2. Local Agency
3. Federal Court
1. State Agency
2. State Court
If filed at an agency and/or court, please provide information about a contact person at the agency/court where the complaint was filed:
Agency/Court
Address
City
State
Zip Code
Contact's First Name
Contact's Last Name
Phone Number
Fax Number
Email Address
Electronic Signature Agreement
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
1. I agree.
Electronic Signature
Date of Submission
Date of Submission
Date of Submission

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