| a. | Name, address, and phone number of the individual making the complaint. |
| b. | Basis of the complaint, i.e., race, color, national origin, gender, age, disability, sexual orientation, religion or other. |
| c. | The date or dates on which the alleged discriminatory event(s) occurred. |
| d. | Names, addresses, and phone numbers of person(s) who were allegedly discriminated against. |
| e. | Description of the incident resulting in discrimination. |
| f. | Signature of individual making the complaint. |
| g. | If an individual wishing to make a complaint is unable to write the complaint, MCT staff will assist. Please contact (618) 797-4600 for details. |