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Columbia Area Transit Complaint Form
Hood River County Transportation District does business as Columbia Area Transit - CAT
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number (Home)
Please enter a valid phone number.
Format: (000) 000-0000.
Phone Number (Work)
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Accessible Format Requirements?
Please Select
Large Print
Audio Tape
TDD
Other
None
Date of Issue
-
Month
-
Day
Year
Date
Time of Issue
Hour Minutes
AM
PM
AM/PM Option
What type of complaint would you like to file?
Operational/ Safety Issue
Customer Service
Discrimination (Title VI & ADA)
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Operational/Safety Issue
Bus Number
Staff Member Involved
Detailed Description of the Issue:
Any other critical information that CAT should be aware of?
Follow-up response requested? If yes, staff will respond within 5-7 days.
Yes
No
Who is filing the complaint?
*
Please Select
Customer
Staff member on behalf of individual
Concerned Community Member
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Customer Service
Staff Person Involved
Detailed Description of the Issue:
Any other critical information that CAT should be aware of?
Follow-up response requested? If yes, staff will respond within 5-7 days.
Yes
No
Who is filing the complaint?
*
Please Select
Customer
Staff member on behalf of individual
Concerned Community Member
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Discrimination (Title VI & ADA)
Are you filing this complaint on your own behalf?
Yes
No
If no, please supply the name and relationship of the person for whom you are filing the complaint.
Please explain why you have filed for a third party:
Please confirm that you have obtained the permission of the aggrieved party if you are filing on behalf of a third party.
Yes
No
I believe that the discrimination I experienced was based on (check all that apply):
Race
Color
National Origin
Disability
Explain as clearly as possible what happened and why you believe you were discriminated against. Describe all persons who were involved. Include the name and contact information of the person(s) who discriminated against you (if known) as well as the names and contact information of any witnesses.
Name of the person the complaint is against (if known):
First Name
Last Name
Title of person complaint is against:
Have you previously filed a Discrimination Complaint with Columbia Area Transit?
Yes
No
If yes, please provide any reference information regarding your previous complaint:
Have you filed the current complaint with any other Federal, State, or local agency or with any Federal or State court?
Yes
No
If yes, check all that apply:
Federal Agency
Federal Court
State Court
State Agency
Local Agency
Please provide information about a contact person at the agency/court where the complaint was filed. (Name, Title, Agency, Address, & Phone Number)
Signature
*
A downloadable version of this form can be found at ridecatbus.org.
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You may attach any written materials or other information that you think is relevant to your complaint.
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If a follow-up response was requested a staff member will respond in 5 to 7 days.
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