NAACP Complaint form

NAACP Complaint form
Date of report

Month Day Year
Please check the type of complaint that you are making

Retaliation Discrimination Harassment Housing Civil Rights Violation/Hate Crime
Please select the agency, orgnization and/or person of which you are filling the complant agains
Place of Business: Employer
Date of Incident

Month Day Year
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 Country
Phone Number

Area Code Phone Number
E-mail
Do you currently have an attorney working on your behalf?

Yes No Not Sure
Attorneys Name

First Name Last Name
Attorneys E-mail
Attorneys Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Attorneys Phone Number

Area Code Phone Number
Has a lawsuit been filed?

Yes No Not sure
If yes when filled?

Month Day Year
Case #?
Right to sue letter?

Yes No Not sure
Have you filed a Fair Employment & Housing complaint?

Yes No Not sure
Comments
Description of Incident
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.
Type name for signature
Date

Month Day Year
Should be Empty:

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Please give us some information about yourself: