No cost to riders · On-demand ·
Open to everyone in Meigs County
Mon–Fri · 7:00 AM – 4:00 PMFollow us on Facebook
Home  ›  Accessibility  ›  File a Complaint

ADA & Title VI Complaint Form

Fill this form in on screen and send it by email, or print it and complete it by hand. You may also file by phone, by Ohio Relay Service, or in person.

Go to the form ↓

Before you begin

Your complaint must be filed within 180 days of the alleged discrimination. Filing after 180 days may result in dismissal. You may attach any additional written materials or other information you think is relevant.

Other ways to file, all equally accepted:
By phone: (740) 444-8121 · Ohio Relay Service: 711
By email: Theresa.Lavender@jfs.ohio.gov
In person or by mail:
Meigs County Public Transit · 117 East Memorial Drive · Pomeroy, Ohio 45769
Assistance completing this form is available on request, and we can provide it in an alternative format.

If information is needed in another language, contact 1-800-535-7749.

Prefer the printed form? Download the PDF version.

Complaint form

Type of complaint
Part I — Your information
Additional formats needed
Part II — Who this complaint is for
Are you filing this complaint on your own behalf?

If yes, skip to Part III. If no, complete the three questions below.

Confirm
Part III — What happened
I believe the discrimination I experienced was based on:
Part IV — Previous complaints with MCPT
Have you previously filed an ADA and/or Title VI complaint with this agency?
Part V — Complaints filed elsewhere
Have you filed this complaint with any other Federal, State, or local agency, or with any Federal or State court?
If yes, check all that apply

Contact information for a person at the agency or court where the complaint was filed:

Part VI — Agency the complaint is against
Important notice: To protect your rights, your complaint must be filed within 180 days following the date of the alleged discrimination. Failure to file within 180 days may result in dismissal of the complaint. You may attach any additional written materials or other information that you think is relevant to your complaint.
Signature

Typing your name below acts as your signature. If you print this form, please sign it by hand before returning it.

Submitting opens your email app with your complaint addressed to Theresa Lavender, Civil Rights Coordinator. You may also print and return the form by mail or in person.

You may also file directly with the FTA

Federal Transit Administration, Office of Civil Rights, Attention: Title VI Program Coordinator, East Building, 5th Floor-TCR, 1200 New Jersey Ave. SE, Washington, DC 20590.