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5 Formulario de Denuncia del Título VI, Página 2 FORMULARIO DE DENUNCIA Sección IV: 14. ¿Ha presentado anteriormente una denuncia del Título VI ante Goodwill Serving the People of Southern Los Angeles County? Sección V: 15. ¿Ha presentado esta queja ante cualquier otra agencia federal, estatal o local, o ante cualquier tribunal federal o estatal? [ ] SÍ* [ ] NO Si la respuesta es sí, marque todo lo que corresponda: [ ] Agencia federal [ ] Agencia estatal SÍ [ ] Tribunal federal NO [ ] Agencia local [ ] Tribunal estatal 16. Si ha respondido afirmativamente a la pregunta #15, facilite información sobre una persona de contacto en la agencia/tribunal donde se presentó la denuncia. Nombre: Cargo: Agencia: Dirección: Teléfono: Sección VI: Nombre de la Agencia de Tránsito contra la que se presenta la queja: Persona de contacto: Teléfono: Puede adjuntar cualquier material escrito u otra información que considere relevante para su queja. Se requiere la firma y la fecha a continuación para completar el formulario: Firma Fecha Por favor, presente este formulario en persona o envíelo por correo a la dirección que aparece a continuación: Coordinador del Título VI/Oficial de Cumplimiento Corporativo 800 W. Pacific Coast Hwy Long Beach, CA
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