Discrimination Form

Discrimination Complaint

Complainant Name(Required)
Location of Alleged Disciminatory Act
Complainant Is Alleging Discrimination Occurred On The Basis Of(Required)
Please provide a description of the act. Is it housing, employment, public accommodation, or something else?
Respondent Name
(The individual, employer or organization that allegedly engaged in discriminatory action.)
Any Names of Witnesses of Alleged Discriminatory Act
Has This Complaint Been Filed with Any Other Agency?
Max. file size: 250 MB.