601 2nd Avenue SE, Cedar Rapids, IA 52406 (319) 449-4397 naacpcr4013@gmail.com

The NAACP’s principal objective is to ensure the political, educational, social and economic equality of U.S. minority group citizens & eliminate race prejudice.

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Cedar Rapids NAACP Chapter #4013 COMPLAINT FORM

Today's Date(required)

Name of Person Making Complaint

Home Address

Email Address

Phone Number

Respondent(s) (Person/Agency/Company/Business against whom the complaint is lodged:

Respondent's address

Nature of complaint

Housing

Employment

Government agency

Public accommodations

Type or Basis of Discrimination

Race

Color

National Origin

Sex/Gender identity

Religion

Disability

Age

Sexual orientation

Date (or dates) incident(s) occurred

Less than 180 days ago? Yes

No

Summary of what happened (detail why you believe you are a victim of one of the above types of discrimination)(required)

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Location

601 2nd Avenue SE
Cedar Rapids, IA 52406

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