NAACP Branch #5130 Complaint Form
If you have a civil right complaint against a person or an organization and you want to contact us, please let us know about it by completing this form.
Date of report:
-
Month
-
Day
Year
Date
Are you a member of the St. Petersburg Branch NAACP?
Yes
No
Please select the type of complaint that you are making:
Retaliation
Discrimination
Harassment
Housing
Civil Rights Violation / Hate Crime
Sexual Orientation
Please select the agency, organization and/or person of which you are filing the complaint against:
Law Enforcement
School District
Government Agency
Employer
Other
Date of Incident:
-
Month
-
Day
Year
Date
Please give us some information about yourself:
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Format: (000) 000-0000.
Email
Do you currently have an attorney working on your behalf?
Yes
No
Not Sure
Other
Has a lawsuit been filed?
Yes
No
Not Sure
Description of Incident:
I do hereby authorize the NAACP Committee to investigate my complaint. 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.
Signature
Date
-
Month
-
Day
Year
Date
Submit
Should be Empty: