NAACP Houston Branch Education Complaint Form

NAACP Houston Branch Education Complaint Form

Please be advised this form is to be used for issues involving Houston and surrounding independent school districts. Completing this form does not constitute filing an official complaint with a legal authority. The NAACP Houston Branch is seeking additional information to assist you concerning an education related complaint.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*

Confirmation Emailexample@example.com
Select School District*

Houston Independent School District (HISD)Other School District
Please provide School Name*
When did the alleged discrimination begin; and is it still on-going.*

Issue of Concern (select all that apply)*

School PolicySpecial Programs (i.e. Magnet, Dual Language, Dual Credit, etc)Special EducationSpecific Principal/Teacher/School Staff MemberDisciplinary ActionDistrict-wide Policy
What is the School Policy?*
What is the name of the Special Program?*
What is the District-wide Policy?*
Issue - What is the Name of the Principal/Teacher/School Staff Member?*
Please provide details of your complaint*
Please upload any supporting documentation and/or pictures

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1. I AFFIRM THAT THE INFORMATION PROVIDED BY ME ABOVE IS TRUE TO THE BEST OF KNOWLEDGE, INFORMATION AND BELIEF.

2. I, (NAME LISTED ABOVE), currently reside at (LISTED ABOVE). By submitting this document, I affirm that I understand and agree with it.

a. I have submitted to the 6183 Unit of the NAACP a complaint against (LISTED ABOVE).

b. I understand that the NAACP Houston Branch is a private, non-profit, voluntary organization. It is not a government agency. Filing a complaint with the NAACP Houston Branch is not the same as filing a complaint with an administrative agency or filing a suit in a complaint with an administrative agency or filing suit with a court of law. Whatever rights I have to file a complaint with an administrative agency or to file a civil lawsuit are completely unaffected by whether or not I have filed with the NAACP Houston Branch.
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