PHX At Your Service logo

Title VI Complaint Form

Please note!

Under Title VI of the 1964 Civil Rights Act (as amended) and related statues, the City of Phoenix must ensure that no person shall, on the basis of race, color or national origin be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance.

To file a complaint online, please complete and then submit this form. It is pre-addressed to arrive at the correct destination when you click on the “Submit” button below.

If you have questions or comments about the process, or want to email the ADA/Title VI Coordinator directly , please use this email address:

In order for us to respond to your message appropriately, please fill in as much of the following information in this form on this page as possible.

A city staff person will contact you as soon as possible after you submit this form.

gear icon Loading

Please wait while your form is submitted.

*denotes required field

Incident Information *

Customer Information

Incident Information

(Please enter in format: HH:MM AM/PM)
(Month, Date, Year; i.e. Jan. 1, 2019)
Major Crossroads: *

Crossroad One:

Crossroad Two:

Operator Name and/or Description:

Additional Vehicle Information:

Complaint Details


Additional Complaint Information



Please attach any additional material that is relevant to your complaint.

The combined size of all uploaded files is limited to 20MB.
File Size:
File Size:
File Size:
File Size:

Electronic Signature *

Please enter your full legal name above. This will be considered your signature.