Thank you for completing this complaint form. Mesa Gateway Airport Authority (MGAA) is committed to ensuring that no person is excluded from participation, denied benefits of, or subjected to discrimination at the Airport.
The following information is necessary to assist us in processing your complaint. If you require any assistance in completing this form, please contact Veronica Lewis, Title VI Coordinator by calling 480-988-7622 or
e-mailing . Complaints must be filed within 180 days of the alleged incident.
Complainant Information
Name:
Phone number:
*
Email:
*
Street Address:
City, State, Zip and Country:
Person(s) discriminated against (if someone different than complainant)
Name:
Street Address:
City, State, Zip and Country:
Incident Description
Location of Incident:
Please describe in detail the
alleged discrimination and
the names of those responsible.
Why do you think the incident
occured, and how could it
have been avoided?
How can this issue be
resolved to your satisfaction?
Was there a witness? Please
provide contact information
including name, address, phone
number, and eamil address
if known.
Additional Information
If you answered "Yes," please provide the following information.
Agency
Contact Name
Agency
Contact Name
I affirm that all information in this complaint is true and complete to the best of my knowledge and belief.
Signature
(Typed for electronic submital)
*
A staff member will contact you within one week.
If you would like to be contacted, please provide your email address or phone number. We will do our best to contact you within three business days.
Printed forms can be submitted to:
Mesa Gateway Airport Authority
Veronica Lewis, Title VI Coordinator
5835 S. Sossaman Road
Mesa, AZ 85212
- OR -