Los Angeles County Public Works (Public Works) is committed to ensuring compliance with Title VI of the Civil Rights Act of 1964 and other nondiscrimination authorities, 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 sponsored or implemented by Public Works on the grounds of race, color, national origin, sex, age, disability, religion, sexual orientation, gender identity, or any other category protected by State or Federal law. If you believe you have been discriminated against, please complete this form.

Person Completing Form (select one):

* An authorized representative is a person with authority to act in the best interest of the participant.

Customer Information:

Authorized Representative (if applicable):


Accessibility Complaint Information:

I believe the discrimination I experienced was based on (check all that apply):


Please describe how Public Works has not complied with delivering its programs and services. Provide sufficient details to support your complaint.