Title VI Self-Identification Survey Thank you for attending our public meeting. May we have a few minutes of your time?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)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Meeting Time:(Required) Hours : MM AM PM AM/PM Gender: Female Male Age: 1-20 21-39 40-64 65+ Veteran Status: No Yes Disabled: No 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 You may also download our Title VI self-identification survey as a PDF in English and Spanish.