N.A.A.C.P. STEUBENVILLE BRANCH UNIT #3203 HUMAN RIGHT COMPLAINT FORM

B. For all other complaints please complete the following:
Who discriminated against you?
Location of incident?
Description of incident:
C. Witnesse #1 to the incident:
Name
Address
Phone
Occupation
C. Witnesse #1 to the incident:
Name
Address
Phone
Occupation
D. Describe what happened:
I PRINT NAMEdo 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 their scope of their influence and ability.

The Steubenville Branch will make every effort to provide some degree of assistance to its members. If you are not now a member, please request a member ship envelope now and join!
Signature*

Clear
Date*

MonthDayYear
Date
Witness*
Submit completed forms to: N.A.A.C.P. Steubenville, P.O. BOX 533 STEUBENVILLE, OHIO 43952, or naacp3203@gmail.com.
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P.O. BOX 533 STEUBENVILLE, OH 43952 | (740) 214-6238 | naacp3203@gmail.com | $NAACP3203 | @steubnaacp
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