Your Rights Under Title VI

For info about Title VI if you believe you’ve been segregated against on the basis of race, color, or national origin by SADI, file a Title VI by completing the Title VI Complaint form.

SADI agrees to comply with all provisions prohibiting discrimination on the basis of race, color, or national origin of Title VI of the Civil Rights Act of 1964, as amended, 42 U.S.C. 200d et seq., and with U.S. DOT regulations, “Nondiscrimination in Federally-Assisted Programs of the Department of Transportation—Effectuation of Title VI of the Civil Rights Act,” 49 CFR part 21.

SEMO Alliance for Disability Independence (SADI) posts Title VI notices on our agency’s website, in public areas of our agency, and on our buses and/or paratransit vehicles.

SADI operates its programs and services without regard to race, color, or national origin, in accordance with Title VI of the Civil Rights Act of 1964.

If you believe you have been discriminated against on the basis of race, color, or national origin by SADI, you may file a Title VI complaint by completing and submitting the agency’s Title VI Complaint Form.

Independent Living resources at SADI in Missouri

How To File A Title VI Complaint

To obtain a Complaint Form please contact SADI at (573) 651-6464, download a digital copy to mail in or fill out the form below.
A mailed version of the complaint can be sent directly to the Executive Director/Title VI Officer, Maryann Gudermuth. If you are mailing the form, please send it to the following address:Maryann Gudermuth, Executive Director/Title VI Officer
SEMO Alliance for Disability Independence
1913 Rusmar Street
Cape Girardeau, Missouri 63703.
In addition to the complaint process at SADI, complaints may be filed directly with the Federal Transit Administration, Office of Civil Rights, Region VII, (816) 329-3920.
Complaints must be filed within 180 days following the date of the alleged discriminatory occurrence and should contain as much detailed information about the alleged discrimination as possible.
A physical copy of the form must be signed and dated, and include your contact information. Digital submissions do not require this step.

No person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance.

Title VI Complaint:

If you feel that you have been discriminated against in the provision of transportation services, please provide the following information to assist us in processing your complaint. Should you require any assistance in completing this form or need information in alternate formats, please let us know. An asterisk indicates that the selected field is required before submission.

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Complainant’s Name

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Address

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Apt/Suite

City

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State

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Zip

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Phone

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Preferred Contact

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Preferred Contact

Are You Filing This Complaint On Your Own Behalf?

Please select whether you are filing on the inflicted person or not. We need this for our records.

No, I am filing this complaint on the behalf of someone else. Yes, I am filing this complaint on my own behalf. Please skip any unrelated questions.

Person Filing Complaint:

Please provide us with your contact information if you are filing this complaint on the behalf of someone else.

Name

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Address

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Apt/Suite

City

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State

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Zip

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Phone

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Please enter the email address of the person this is being filed for. We need this for our records.

Relationship to the Person for Whom You Are Filing the Complaint

Please enter your relationship of the person this is being filed for. We need this for our records.

Please Confirm You’ve Obtained Permission of the Aggrieved Party If You Are Filing on Behalf of a Third Party.

Please enter whether or not you have permission from the person this is being filed for. We need this for our records.

No, I do not have their permission to file this complaint. Yes, I have their permission to file this complaint.

The Incident:

Please describe the discrimination incident so that we may have a better idea of the situation that took place.

I believe the discrimination experienced was based on:

Please enter which discrimation was experienced. We need this to understand the situation.

Race (protected by Title VI) Color (protected by Title VI)

National Origin (protected by Title VI) Other

Date of Alleged Discrimination (Month/Day/Year)

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Where Did the Alleged Discrimination Take Place?

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Explain As Clearly As Possible What Happened And Why You Believe You Were Discriminated Against

Please describe the acts of discrimination. We need this for our records.

Person(s) Involved:

Describe all of the persons that were involved. Include the name and contact information of the person(s) who discriminated against you (if known).

Name of Person Involved

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Phone or Email of Person Involved

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Would You Like To Add Another Person Involved? Add Person

Witness(es):

Please list any and all witnesses’ names and phone numbers/contact information.

Name of Witness

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Phone or Email of Witness

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Would You Like To Add Another Witness? Add Witness

Action:

What type of corrective action would you like to see taken?

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Have You Filed A Complaint With Any Other Federal, State, or Local Agency, or With Any Federal, County or State Court?

Please indicate whether you have or have not filed a complaint with any Federal, State, County, or Local Offices. We need this for our records.

No, I have not filed. Yes, I have already filed with the following:

Federal, State, County and Local Options

Please select and fill out all locations in which a complaint has been filed to.

Please select at least one of Federal, State, County, or Local Offices you've filed to. We need this for our records.

Federal Agency

Name of Personnel

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Personnel Title

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Agency Name

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Phone of Personnel

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Address

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City

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State

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Zip

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Federal Court

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Personnel Title

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Agency Name

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Phone of Personnel

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Address

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City

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State

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Zip

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State Court

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Personnel Title

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Agency Name

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Phone of Personnel

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Address

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City

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State

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Zip

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State Agency

Name of Personnel

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Personnel Title

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Agency Name

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Phone of Personnel

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Address

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City

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State

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Zip

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County Court

Name of Personnel

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Personnel Title

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Agency Name

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Phone of Personnel

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Address

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City

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State

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Zip

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Local Agency

Name of Personnel

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Personnel Title

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Agency Name

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Phone of Personnel

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Address

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City

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State

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Zip

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