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 check one or more that apply Housing Employment Government agency Public accommodations Type or Basis of Discrimination check one or more that apply 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) Submit Share this:TwitterFacebookLike this:Like Loading...
