Title VI Self-Identification Survey

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PAG’s goal is to ensure that every effort will be made to prevent discrimination through the impact of its programs, policies and activities. We will take reasonable steps to provide meaningful access to services and activities for persons with limited English proficiency. PAG will use survey results to determine who attends its public meetings and how to improve participation.

The survey helps fulfill federal reporting requirements.

If you voluntarily complete this survey, please mark all that apply.

Committee:(Required)

PAG Regional Council

Management Committee

Transportation Planning Committee

Environmental Planning Advisory Committee

Other

Ethnicity/Race:

American Indian/Alaskan Native

Asian/Pacific Islander

Hispanic/Latino

African American/Black

White

Other/Not Listed

Other/Not Listed:

Meeting Date:(Required)

Meeting Time:(Required)

Gender:

Female

Male

Age:

1-20

21-39

40-64

65+

Veteran Status:

Yes

Disabled:

Yes

Title VI of the 1964 Civil Rights Act, as amended, 42 USC2000d, and PAG regulations provide that “no person in the United States shall, on the grounds 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.”

Title VI authorities:

Federal-Aid Highway Act of 1973
Section 504 of the Rehabilitation Act of 1973
Americans with Disabilities Act of 1990
Age Discrimination Act of 1975
Uniform Relocation Act of 1970
Executive orders 12898 and 13166

Thank you for attending our public meeting. May we have a few minutes of your time?

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