goldenagecenter.org

Title VI

THE GOLDEN AGE CENTER, INC.

TITLE VI PROGRAM

201 Browns Ranch Rd.

P.O. Box 1413

Weaverville, CA  96093

(530) 623-2324

Developed:   SEPTEMBER 2015

Text Box: Notifying the Public of Rights Under Title VI THE GOLDEN AGE CENTER, INC. is committed to ensuring that no person shall be excluded from the equal distribution of its services and amenities because of race, color or national origin in accordance with Title VI of the Civil Rights Act of 1964. Any person, who believes she or he has been discriminated against, may file a signed, written complaint within one hundred eighty (180) days of the date of alleged discrimination. The Title VI Complaint form may be requested in person from the GOLDEN AGE CENTER office at 201 Browns Ranch Rd., Weaverville, CA 96093, or by phone at (530) 623-2324. All complaints will be fairly and objectively investigated. The complaint should include the following information: 1. Complainant’s name, address, and contact information (i.e., telephone number, email address, etc.) 2. Description of how, when, where and why complainant believes the discrimination occurred. In addition, the location, names, and contact information of any witnesses should also be included. The completed form should be returned to: THE GOLDEN AGE CENTER, INC., Attention: Executive Director, P.O. Box 1413, Weaverville, CA 96093 In addition to the Title VI complaint process at THE GOLDEN AGE CENTER, INC., a complainant may file a Title VI complaint with the: 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 For more information about THE GOLDEN AGE CENTER’S Title VI program, complaint procedure, and/or to request information in another language, contact (530) 623-2324, or visit the office at 201 Browns Ranch Rd, Weaverville, CA 96093. Si se necessita información en español, llame (530) 623-2324

Title VI Complaint Procedures

Any person who believes she or he has been discriminated against on the basis of race, color, and/or national origin may file a complaint with THE GOLDEN AGE CENTER, INC. by completing and submitting  THE GOLDN AGE CENTER, INC.’s  Title VI Complaint Form or by contacting the Federal Transit Authority (see below for contact information).  

Complaints will be made in writing and will include all information relevant to a determination of discrimination.   If a complaint form is received and is not complete, THE GOLDEN AGE CENTER, INC. will be unable to process the complaint.  A complaint will be filed within one hundred eighty (180) days after the alleged discrimination.   If a complainant is unable or incapable of providing a written statement, a GOLDEN AGE CENTER, INC. designee will, if necessary, assist the person in converting verbal complaints to writing and will interview the complainant.  The complainant or his/her representative will sign all complaints.

Within five (5) business days of receiving a complaint, a letter will be sent to the complainant acknowledging receipt of the completed form or requesting the complaint be completed and returned within ten (10) business days.  If the requested information is not received within ten (10) business days the case will be closed.

Within thirty (30) business days of receiving the complaint, THE GOLDEN AGE CENTER, INC. administration will review the complaint, which will include, but not be limited to, interviewing all appropriate personnel, the complainant, witnesses and review THE GOLDEN AGE CENTER, INC.’s policies and service standards. The complainant will be notified in writing of the cause to any planned extension to the 30-day rule. If it is found that discrimination did not occur, the complainant will be notified in writing and the procedure will be terminated.  At that time the complainant will be advised of their right to challenge the decision of THE GOLDEN AGE CENTER, INC. by submitting a written request for a hearing within five (5) days of the receipt of the determination.

If after review of the complaint, it is found that discrimination may have occurred, a formal hearing will be held.  The complainant will be notified of this determination within reasonable time of the submission of the complaint.  The hearing will occur on an available and mutually agreed upon date among both parties and will be attended by the Executive Director , the complainant and appropriate personnel.  Following the hearing, THE GOLDEN AGE CENTER, INC. will make a final determination.  The complainant will be notified of this determination within ten (10) business days of the hearing.  If justified, appropriate remedial action will be taken.  The decision will be considered final.

If the Administrator finds that discrimination did not occur, the complainant will be notified of that disposition and will advise the complainant of their right to submit their complaint to the Federal Transit Administration, Office of Civil Rights, Attention: Title VI Program Coordinator, East Building, 5th Floor-TCR, 1200 New Jersey Ave., SE, Washington DC 20490, for further investigation.

Text Box: THE GOLDEN AGE CENTER, INC. P.O. BOX 1413, 201 BROWNS RANCH RD., Weaverville, CA 96093 TITLE VI DISCRIMINATION COMPLAINT FORM Complainant’s Name: ________________________________________________________________________________ Street Address: _________________________________________________________ Mailing Address: _____________________________________________________________________________________ City/State/Zip: __________________________________________________________ Phone:_________________________________________ E-Mail Address: ______________________________ Date of Violation: ______________________ Time of Violation: _____________________________ Date of Complaint: _________________ Place of Violation: ____________________________ Bus Number: __ Bus Route: ___________________________________________ Discrimination because of: □ Race □ Color □ National Origin Please provide the name(s) of the THE GOLDEN AGE CENTER, INC. employee(s) who allegedly discriminated against you, including their job titles (if known). _________________________________________________________________________________________________________________________ Identify what GOLDEN AGE CENTER, INC. service, program, or activity did not comply with Title VI of the Civil Rights Act of 1964. __________________________________________________________________________________________________________________________ Identify any witnesses that have information relating to the violation by name, address and phone number. _________________________________________________________________________________________________________ Explain as clearly as possible what happened, how you feel you were discriminated against and who was involved. Please include how other individuals were treated differently from you. If more space is needed additional page(s) may be attached. ______________________________________________________________________________________________________________________________ Signature of Complainant: ________________________________________________________Date: __________________________