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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 voluntary <br /> and that you are not required to disclose the statistical data requested to participate in <br /> 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 NCDOT <br /> Title VI Program at telephone number 919 . 508 . 1808 or email at titlevi ( ncdot . gov . <br /> Project Name : Date : f <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 /> FY27 VOLUNTARY TITLE VI PUBLIC INVOLVEMENT <br /> Last Updated : 02/ 11 /2025 <br />