File a Complaint

File a Complaint

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Your Information
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Email*
example@example.com
Address (In Case We Have to Mail You Legal Documents)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your Ethnic Background
Your Religion
Gender

MaleFemaleRather Not Say
Incident Information

My Complaint is Against the Following
This Complaint is Against
Please list the agency, employer, business, school or other offending party.
Person or Individual Name
Email
example@example.com
Phone Number

Area CodePhone Number
Date(s) of Incident
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Incident Summary
Please briefly describe your incident.
Do you authorize CAIR-Texas DFW to give the media your contact information?*

YesNo
Agreement
I, the individual submitting this online form, understand that submission of this application is not a guarantee of assistance. I understand that I may be required to submit additional information and I agree to do so in a timely manner. I understand that failure to cooperate with information requests or other assistance-related requests may result in my application for assistance being denied. I understand that submitting this form does not establish attorney–client privilege.
Agreement

Yes, I agree
Please verify that you are human*
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Your Information