ODOT Form T1-01 "Americans With Disabilities Act - Title I Complaint Form" - Oklahoma

What Is ODOT Form T1-01?

This is a legal form that was released by the Oklahoma Department of Transportation - a government authority operating within Oklahoma. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 16, 2020;
  • The latest edition provided by the Oklahoma Department of Transportation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of ODOT Form T1-01 by clicking the link below or browse more documents and templates provided by the Oklahoma Department of Transportation.

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Download ODOT Form T1-01 "Americans With Disabilities Act - Title I Complaint Form" - Oklahoma

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AMERICANS WITH DISABILITIES ACT - TITLE I COMPLAINT FORM
The Oklahoma Department of Transportation (ODOT) ensures that no person or groups of persons shall, on the grounds
of race, color, sex, religion, national origin, age, disability, retaliation or genetic information, be excluded from participation
in, be denied the benefits of, or otherwise be subjected to discrimination under any and all programs, services, or activities
administered by ODOT, its recipients, sub-recipients, and contractors. To request an accommodation please contact the
ADA Coordinator at 405-521-4140 or the Oklahoma Relay Service at 1-800-722-0353. If you have any ADA or Title VI
questions email ODOT-ada-titlevi@odot.org.
Date of Filing:
Name:
Address:
City, State, Zip Code:
Work Phone:
Home Phone:
Email Address:
Date of Alleged Incident:
Indicate below the person(s) who you believe discriminated against you:
Name(s):
Work Location:
Work Phone:
Please provide a detailed description of the alleged incidence of discrimination. If there are any
witnesses, please provide their contact information. Attach additional pages as necessary.
Page 1 of 3
ODOT Form T1-01
Revised 04/16/2020
AMERICANS WITH DISABILITIES ACT - TITLE I COMPLAINT FORM
The Oklahoma Department of Transportation (ODOT) ensures that no person or groups of persons shall, on the grounds
of race, color, sex, religion, national origin, age, disability, retaliation or genetic information, be excluded from participation
in, be denied the benefits of, or otherwise be subjected to discrimination under any and all programs, services, or activities
administered by ODOT, its recipients, sub-recipients, and contractors. To request an accommodation please contact the
ADA Coordinator at 405-521-4140 or the Oklahoma Relay Service at 1-800-722-0353. If you have any ADA or Title VI
questions email ODOT-ada-titlevi@odot.org.
Date of Filing:
Name:
Address:
City, State, Zip Code:
Work Phone:
Home Phone:
Email Address:
Date of Alleged Incident:
Indicate below the person(s) who you believe discriminated against you:
Name(s):
Work Location:
Work Phone:
Please provide a detailed description of the alleged incidence of discrimination. If there are any
witnesses, please provide their contact information. Attach additional pages as necessary.
Page 1 of 3
ODOT Form T1-01
Revised 04/16/2020
Please provide a suggested detailed plan or remedy for this complaint. Attach additional pages as
necessary.
Have you filed or do you intend to file a complaint concerning this incident with any other agencies
(Federal, State or Local)?
Yes
No
If so, please provide the following information:
Agency Name:
Address:
Name of Investigator:
Phone Number:
Email Address:
Date Filed:
Status of Complaint:
Page 2 of 3
ODOT Form T1-01
Revised 04/16/2020
Please attach and/or provide any additional information that might be useful in
processing your complaint.
The completed form must be submitted to the Oklahoma Department of Transportation’s Civil
Rights Division. If you require any assistance in filling out this form, please contact the
ADA/504/508 Coordinator at 405-521-4140.
Signature
Date
Page 3 of 3
ODOT Form T1-01
Revised 04/16/2020
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