[ENTITY NAME, logo, etc.]
Title VI Nondiscrimination Statement
Título VI Declaración de Prohibición de
Discriminación

[ENTITY NAME] ensures compliance with Title VI of the Civil Rights Act of 1964; 49 CFR, part 21; related statutes and regulations to the end that no person shall be excluded from participation in or be denied the benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance from the U.S. Department of Transportation on the grounds of race, color, or national origin.

[ENTITY NAME] asegura el cumplimiento del Título VI del Acto de Derechos Civiles de 1964; 49 CFR, Parte 21, relacionados estatutos y normas para asegurar que ninguna persona sea excluida o discriminada, o que se le nieguen los beneficios de cualquier programa o actividad la cual reciba ayuda financiera federal del Departamento de Transporte de los Estados Unidos sin importar su raza, color, o origen nacional.

Any person who believes he or she has been discriminated against can file a complaint with the appropriate agency:

Cualquier persona que crea que ha sido discriminada puede presentar una queja ante la agencia correspondiente.

TN Department of Transportation	TN Human Rights Commission	FHWA Office of Civil Rights 	FTA Office of Civil Rights 	
505 Deaderick Street Suite 1800, James K. Polk Building Nashville, TN 37243-0347
888.370.3647
	William R. Snodgrass BLD/TN Towers, 312
Rosa Parks AVE, 23rd Floor, Nashville, TN 37243
800.251.3589
	1200 New Jersey AVE, S.E., 8th Floor E81-314,
Washington, DC 20591
202.366.0693	Title VI Coordinator
East Building, 5th Floor -TCR, 1200 New Jersey AVE, S.E.
Washington, DC 20590
888.446.4511	

Entity Name
Name of Title VI Coordinator
Title VI Coordinator
Street Address
City, ST ZIP
Phone number, etc.