Editing previous response:

Please fix the highlighted areas below before submitting.

Civil Rights Complaint Form (optional)

Name

Answer required for "Name"

Address

Answer required for "Address"

Phone Number

Answer required for "Phone Number"

Answer required for "Email"

What happened to you? Please include date, location and any supporting documentation that would help show what happened.

Answer required for "What happened to you? Please include date, location and any supporting documentation that would help show what happened."

Who do you believe discriminated against you? List name(s).

Answer required for "Who do you believe discriminated against you? List name(s)."

Name(s) of witness(es) to alleged prohibited conduct if applicable:

Answer required for "Name(s) of witness(es) to alleged prohibited conduct if applicable:"

It is a violation of the law to discriminate against you based on the following: race, color, national origin, religion, sex (including gender identity and sexual orientation), disability, age, marital status, sexual orientation, family/parental status, income derived from a public assistance program, and political beliefs. I believe I was discriminated against based on my:

Answer required for "It is a violation of the law to discriminate against you based on the following: race, color, national origin, religion, sex (including gender identity and sexual orientation), disability, age, marital status, sexual orientation, family/parental status, income derived from a public assistance program, and political beliefs. I believe I was discriminated against based on my:"

How would you like to see this complaint resolved?

Answer required for "How would you like to see this complaint resolved?"

Submit Form within 180 days of the alleged discriminatory action. Forms can be submitted online or complaints can be made via email to [email protected].