Non-Discrimination Policy

Non-Discrimination Policy

The Town of Chili is committed to providing non-discriminatory service to ensure that no person is excluded from participation in, or denied the benefits of, or subjected to discrimination, in the receipt of its services on the basis of race, color, national origin or disability as protected by Title VI of the Civil Rights Act of 1964 (“Title VI”) and the Americans with Disabilities Act (ADA).

The Town of Chili will make reasonable accommodations to individuals with disabilities who require accommodation to access transportation services.

If you believe you have been subjected to discrimination and would like to submit a written complaint, please complete the following:

Your Name (required):

Address:

City, State ZIP:

Home Telephone:

Work Telephone:

Cell Telephone:

Email Address (required):

Complaint Details:

Basis of Complaint:
RaceColorSexNational OriginAgeDisabilityLow IncomeLimited English Proficiency

Type of Complaint:
ProgramServiceBenefitActivity

Who is alleged to have discriminated against you?

Name (required):

Address:

City, State ZIP:

Telephone:

If an organization, what is its name?

Organization Name (required):

Address:

City, State ZIP:

Telephone:

Name of Contact:

How were you allegedly discriminated against?

How were you discriminated against?

When did the discrimination occur?

Were there witnesses to the discrimination? Please provide their name, title, and telephone number:

What can we do to resolve the complaint?

Have you filed your complaint with anyone else? If so, please list below:

Name:

When:

Complaint Number, if known:

Do you have an attorney in this matter?

Name (required):

Address:

City, State ZIP:

When did you acquire the attorney?: