How to File a Title VI Complaint?

You may file a signed, written complaint 180 days from the date of alleged discrimination. Below are printable forms as well as forms that may be completed online  You may also call our Customer Service desk at 707-543-3333 to request that a Title VI Complaint Form to be mailed to you.

Printable Complaint Form

ENGLISH Title VI Complaint Form

SPANISH Formulario de Queja de Titulo VI

Online Complaint Form

ENGLISH Title VI Complaint Form

SPANISH Formulario de Queja de Titulo VI

Additional Options for Submitting a Complaint Form

You may also submit a signed, written statement that contains the following information:

  • Your name, mailing address, and how to contact you (i.e., telephone number, email address, etc.)
  • The basis of the complaint (e.g., race, color, and/or national origin).
  • The date on which the alleged discriminatory incident occurred.
  • A detailed description of the incident, e.g., how, when, where, and why you believe you were discriminated against. Include names and contact information of any witnesses. If the incident occurred onboard a bus, please provide the time of day, route number, and bus number if available.
  • Other information that you deem significant.

The complaint may be mailed or delivered to the City of Santa Rosa Risk Manager at the following address:

City of Santa Rosa
Human Resources Department
Attn: Risk Manager
100 Santa Rosa Avenue., Room 1
Santa Rosa, CA 95404
Phone: 707-543-3060

CityBus encourages all complainants to certify all mail that is sent through the U.S. Postal Service and / or ensure that all written correspondence can be tracked easily.

Assistance with Filling Out a Complaint Form

The Transit Division's Title VI Program Officer may assist with writing a complaint if the complainant is unable to do so. The Title VI Program Officer shall also provide appropriate assistance to complainants, including persons with disabilities or those who are limited in their ability to communicate in English. You may contact the Title VI Program Officer by phone at 707-543-3333.