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NAINTEGRATED <br /> MOBILITY <br /> DIVISION <br /> VOLUNTARY TITLE VI PUBLIC INVOLVEMENT <br /> Title VI of the Civil Rights Act of 1964 requires the North Carolina Department of <br /> Transportation ( NC DOT) to gather statistical data regarding participants and <br /> beneficiaries of the agency ' s federal - aid programs and activities . NC DOT collects <br /> information on race , color , national origin and gender of the attendees to this public <br /> meeting to ensure the inclusion of all segments of the population impacted by a proposed <br /> project . <br /> NCDOT wishes to clarify that this information gathering process is completely <br /> voluntary and that you are not required to disclose the statistical data requested to <br /> participate in this meeting . This form is a public document used to collect data , only . <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 the <br /> NCDOT Title VI Program at telephone number 919 . 508 . 1808 or email at <br /> titlevi cdot . gov . <br /> Project Name : Date : <br /> Meeting Location : <br /> Name ( please print) Gender : <br /> ❑ Male ❑ Female <br /> General ethnic identification categories ( check one ) <br /> ❑ Caucasian ❑ Hispanic American ❑ American Indian /Alaskan Native <br /> ❑ African ❑ Asian /Pacific Islander Other : <br /> American <br /> Color : National Origin : <br /> After completing this form , please fold and place it inside the designated box on the <br /> registration table . <br /> Thank you for your cooperation . <br /> FY26 VOLUNTARY TITLE VI PUBLIC INVOLVEMENT <br /> Last Updated : 04/01 /2024 <br />