Complaint Form Date of Report(required) Date of Incident Please check the type of complaint that you are making Retaliation Discrimination Harassment Housing Civil Rights Violation/ Hate Crime Select the agency, organization and/or person of which you are filing the complaint against Select one option Law Enforcement School District Government Agency Other Place of Business: Employer Your First Name(required) Your Last Name(required) Mailing Address(required) Mailing Address Line 2 City(required) State(required) Email Address(required) Contact Number(required) Do you currently have an attorney working on your behalf?(required) Select one option Yes No Not Sure Attorney's First Name Attorney's Last Name Attorney's Mailing Address City State Email Contact Phone Number Has a Lawsuit been filed?(required) Select one option Yes No Not Sure If yes, when filed? Case Number? Right to sue letter? Select one option Yes No Not Sure Have you filed a fair employment and Housing complaint? Select one option Yes No Not Sure Comments Description of Incident What would you like the NAACP to do for you regarding the incident(s)?(required) 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. (required) Type name for signature(required) Date of Signature(required) Sumbit Δ
