Title VI Plan
                       (Insert Agency Name)
                         Month, date, year
                  (TVI plan expires 3 years from date approved by the board)
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                                                          Title VI Plan Table of Contents
                  The (Insert Agency Name) Title VI plan includes the following elements:
                           1.  Plan Approval and Revision Log
                           2.  Description of Organization and Service Provided
                           3.  Policy Statement and Notice to the Public
                           4.  Complaint Procedure
                           5.  Complaint Form
                           6.  List of Transit Related Title VI Investigations, Complaints and Lawsuits
                           7.  Public Participation Plan
                           8.  Language Assistance Plan
                           9.  Minority Representation Table and Description
                           10. Providing Assistance to and Monitoring Subrecipients
                           11. Equity Analysis
                           12. Requirements for Fixed Route Transit Providers
                           
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                     Section 1:  Title VI Plan Approval and Revision Log
                                                 Title   VI   Plan   (insert date)
                                                 Adopted on:
                                                 Adopted by:         Name of Board or appropriate governing
                                                                     entity or officials
                                                           Signature(s):  ________________________________________
                     Include documentation to show approval (i.e., minutes, resolutions, ordinance, etc.)
                     Title VI Plan Revision Log
                     Date               Section Revised                                  Summary of Revisions
                     Month/day/year
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                   Section 2:  Description of Organization and Service Provided
                   Insert Description of Organization and Service Provided
                   Within this section please include:
                        1.  A general introduction/summary of your organization
                        2.  The type of service you provide; such as fixed-route, deviated route, or demand response
                            service
                        3.  The number of transit-related employees and the number of revenue service vehicles
                        4.  The area where service is provided; include a service area map, if available.
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