1.1 Complaint Form

Section I:


Accessible Format Requirements?


Section II:


Are you filing this complaint on your own behalf?

*If you answered "yes" to this question, go to Section III.


Please confirm that you have obtained the permission of the aggrieved party if you are filing on behalf of a third party.


Section III:


I believe the discrimination I experienced was based on (check all that apply):


Section IV:


Have you previously filed a Title VI complaint with this agency?


Section V:


Have you filed this complaint with any other Federal, State, or local agency, or with any Federal or State court?

Please provide information about a contact person at the agency/court where the complaint was filed.


Section VI:


* Please fill out all required fields

Submit

Please submit this form in person at the address below, or mail this form to:

Camp Haven Inc.
3256 US Highway 1
Vero Beach, Fl. 32960
Email: outreach@camphaven.net

Title VI complaints may also be submitted to the Federal Transit Administration (see address below). For more information, please visit the FTA at https://www.transit.dot.gov/title6

Federal Transit Administration Office of Civil Rights
Attention: Complaint Team
East Building, 5th Floor-TCR
1200 New Jersey Avenue, SE
Washington, DC. 20590

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