Title VI Self-ID Survey Form

Thank you for attending our public meeting!  May we have a few minutes of your time?

By completing this voluntary survey, CYMPO will be able to determine who attends our public meetings and how we can improve participation. The survey will also help the CYMPO fulfill federal reporting requirements.

Self Identification Survey

Completing this survey is voluntary. If you choose to respond, please mark all that apply.

  • This field is for validation purposes and should be left unchanged.

Title VI of the 1964 Civil Rights Act, as amended, 42 USC 2000d, and U.S. DOT regulations provide that “no person in the US 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.

Other Title VI Non discrimination related authorities:

  • Federal-Aid Highway Act of 1973
  • Section 504 of the Rehabilitation Act of 1973
  • Americans with Disability Act of 1990
  • Executive orders 12898 and 13166

The Central Yavapai MPO’s goal is to ensure that every effort will be made to prevent discrimination through the impact of its programs, policies, and activities.

CYMPO will also take reasonable steps to provide meaningful access to services and activities for persons with limited English proficiency.


Title VI Self-ID Survey Form