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Transit Complaint Form

  1. Section I:

  2. Section II:

  3. *If you answered "yes" to this question go to, section III.

  4. Section III:

  5. I believe the discrimination I experienced was based on(check all that apply):

  6. Section IV:

  7. Have you filed this complaint with (if yes) check all that apply and list agency/court:

  8. Please provide information about a contact person at the agency/court where the complaint was filed.

  9. Section V: Follow up

  10. If yes, what is the best way to reach you? (Choose one)*

  11. ***Signature and date required.

  12. You may also submit this form in person or by paper mail to

    City of Lancaster, Service Safety Director, 104 East Main Street, Lancaster Ohio, 43130

  13. Leave This Blank:

  14. This field is not part of the form submission.