Greater New Haven Transit District

Online Form 3

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Email Address

Is this your first time submitting an appeal about this incident?

Yes

If no, where/when was your first appeal filed?

Please describe the original complaint:

Please describe what the proposed resolution is and why it is not a satisfactory resolution to the discriminatory incident:

Please provide the date and time the discriminatory incident occurred:

Please provide the date of receipt of the initial decision/response:

YYYY