Title VI Coordinator’s Office Complaint Form

Section I

Any person who believes they have been subjected to discrimination on the basis of race, creed, color, gender, or national origin in any program or activity administered by the Port of Seattle has the right to file a complaint with the Port of Seattle. Complaints must be filed within one hundred eighty (180) days following the date of the alleged discriminatory occurrence. The complaint must be filed using this form, must be mailed to the Office of Equity, Diversity, and Inclusion, Title VI Coordinator, P.O. Box 1209, Seattle, WA, 98111, or must be emailed to [email protected]. If a complaint is initially made by phone, it must be supplemented with this Complaint Form within 180 days after the discriminatory event. This is not intended to deny or limit the right of a complainant to file a complaint with an outside agency, such as the U.S. Department of Transportation nor Federal Aviation Administration (FAA), or to seek private legal counsel regarding discrimination.

Title VI Discrimination Complaint Forms may be obtained from the office of the Title VI Coordinator at no cost to the complainant by calling (206) 787-4156 or sending an email to [email protected].

Please mail your completed form to: Port of Seattle, Office of Equity, Diversity, and Inclusion, Title VI Coordinator, P.O. Box 1209, Seattle, WA 98111, or email your completed form to [email protected].

Please fill in your information below.

Basis for complaint

Complainant

Section II

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

Section III

Section IV

Section V

Please note that we cannot accept your complaint without a signature.