Current Contact Information Description of the Incident CompletePlease complete this form to the best of your ability. If you need translation or other assistance, contact Charles Patton, Title VI Coordinator, at 206-971-3285 or cpatton@psrc.org. Name: Address: Address: City/Town: ZIP/Postal Code: What is the best way to contact you? Home Phone Work Phone Mobile Phone Email Home Phone Number: Work Phone Number: Mobile Phone Number: Best time of day to contact you about this complaint: Email:
