Laserfiche WebLink
Voluntary Title VI Public Involvement <br />Title VI of the Civil Right's Act of 1964 requires North Carolina Department of <br />Transportation to gather statistical data on participants and beneficiaries of the agency's <br />federal -aid highway programs and activities. The North Carolina Department of <br />Transportation collects information on race, color, national origin and gender of the <br />attendees to this public meeting to ensure the inclusion of all segments of the population <br />affected by a proposed project. <br />The North Carolina Department of Transportation wishes to clarify that this information <br />gathering process is completely voluntary and that you are not required to disclose the <br />statistical data requested in order to participate in this meeting. This form is a public <br />document. <br />The completed forms will be held on file at the North Carolina Department of <br />Transportation. For Further information regarding this process please contact Shantmy <br />Dickens the Title VI Manager at telephone number 919.508.1896 or email at <br />sddickens(timcdot.gov. <br />Name (please print) I Gender: <br />❑ Male ❑ Female <br />General ethnic identification cateeories (check one) <br />I I African American I I I Asian/Pacific Islander I Other: <br />After you complete this form, please fold it and place it inside the designated box on the <br />registration table. <br />Thank you for your cooperation. <br />Page 136 <br />