Legal Redress Intake Form

Legal Redress Intake Form

Please provide your details and information about your legal complaint to help us assist you.
The purpose of this form is to gather information for the Legal Redress Committee to consider when determining whether the NAACP Little Rock Branch may be able to assist you with your complaint of discrimination. Completing this form does not constitute an official complaint with a legal authority, such as filing a lawsuit or a complaint with a governmental agency. Nor does completing this form establish an attorney-client relationship between the NAACP Little Rock Branch and the complainant.
Full Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Current Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Type of Complaint
Date of Incident

MonthDayYear
Date
Location of Incident
Description of Complaint
Witness Information
Actions Taken Prior to This Submission (e.g., reported to authorities, contacted employer)
Upload Supporting Documentation (if any)

Cancelof
Desired Outcome or Resolution
Check this Box after reading the disclaimer below

The NAACP Little Rock Branch may provide contact information, and/or assistance for concerned citizens with common complaints, issues or questions, but we do not provide legal advice. For legal advice, you should consult an attorney. Please also remember that NAACP members are volunteers and may not always be available to schedule time to assist you at your convenience. If your matter is time sensitive, do not wait for the NAACP.
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