NAACP Complaint form

NAACP Complaint form
Date of report

MonthDayYear
Please check the type of complaint that you are making

RetaliationDiscriminationHarassmentHousingCivil Rights Violation/Hate Crime
Please select the agency, orgnization and/or person of which you are filling the complant agains
Place of Business: Employer
Date of Incident

MonthDayYear
Please give us some information about yourself:
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
E-mail
Do you currently have an attorney working on your behalf?

YesNoNot Sure
Attorneys Name

First NameLast Name
Attorneys E-mail
Attorneys Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Attorneys Phone Number

Area CodePhone Number
Has a lawsuit been filed?

YesNoNot sure
If yes when filled?

MonthDayYear
Case #?
Right to sue letter?

YesNoNot sure
Have you filed a Fair Employment & Housing complaint?

YesNoNot sure
Comments
Description of Incident
I do hereby authorize the NAACP Legal Redress Committee to investigate my complaint and to take any steps necessary to resolve it, and I understand that the NAACP is not a legal entity and that the organization has certain limitations as to the scope of their influence and ability.
Type name for signature
Date

MonthDayYear
Should be Empty:

Please give us some information about yourself: