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KATS BUS
Home
About
Dial-a Ride
Contact
KATS Discrimination Complaint Form
If you have a complaint about the accessibility of our transit system or believe you have been discriminated against because of your race, color, national origin, or disability, you can use this form to file a complaint/appeal.
Please provide all facts and circumstances surrounding your issue or complaint so we can fully investigate the incident.
The Alaska Department of Transportation and Public Facilities and its sub-recipients take complaints on the basis of discrimination very seriously. If you feel you have been discriminated against, please fill out this Discrimination Complaint Form. Anonymous complaints will not be accepted.
Accommodations will be provided for people with disabilities or Limited English Proficiencies. Translation/Interpreter fees will be paid by the AKDOT&PF.
You must file your complaint within 180 days of the alleged discriminatory incident.
Please provide the following information as accurately and completely as possible and sign and date.
*
Indicates required field
Complainant's Name
*
First
Last
Phone Number:
*
Email
*
Address
*
Relationship to person completing form
Are you filling out this form on your own behalf?
*
Yes
No
Maybe
If no, what is your relationship to the person for whom you are filing the complaint?
*
If no, please provide the name, phone and address of the person completing the form.
*
Please indicate if you have permission of the aggreviated party to file a complaint on their behalf:
*
Yes, I have permission
No, I do not have permission
Details about your complaint:
I believe that the discrimination I experienced was based on (check all that apply)
*
Race
Color
National Origin
Accessibility Issue
Discrimination based on disability
Other
Date of alleged Discrimination (month/day/year)
*
Where did the alleged discrimination take place?
*
Explain as clearly as possible what happened and why you believe you were discriminated against.
*
Describe all persons that were involved. Include the name and contact information go the person(s) who discriminated against you, if known. Email additional information to
[email protected]
if you need additional space.
Please list any and all witness' names and contact information.
*
Email to
[email protected]
if you require additional space.
What type of corrective action would you like to see taken?
*
Please check all federal, state, local agencies or federal/state courts with whom you have filed a complaint
*
Federal Agency (list agency name)
Federal Court (please provide location)
State Court
State Agency (list agency name)
Local Court (specify court and location)
Local Agency (list agency name)
Space to provide additional details:
*
Please provide contact information at the agency/court where the complaint was file:
*
By typing in your name in the box below, you indicated your signature attesting to the information in this form.
*
Date of Signature:
*
Submit
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