NAACP Branch 4108- Complaint Form
If you believe you have experienced discrimination, please fill out this form and our Chair of Legal Redress will be in touch.

Please Note: THE NAACP DOES NOT PROVIDE LEGAL ADVICE. YOU ARE ENCOURAGED TO CONTACT PRIVATE
COUNSEL FOR LEGAL ADVICE REGARDING THIS OR ANY MATTER.
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Email *
First and Last Name *
Address *
Date of Birth *
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Please list THREE Personal References below (Name, Address, Occupation, and Phone Number) *
Type of Complaint *
Required
Please explain your complaint in detail. *
Please list any supporting statements (if applicable).
Have you contacted other agencies about this complaint? If so, which ones? *
Have you filed a complaint with your union about this matter? If so, please provide the name of your local representative. *
If you have an attorney, please provide his/her name and address.
Is there any additional information that may have a bearing on the complaint?
Are you a member of the NAACP? *
Please sign by typing your name. *
1. Pursuant to the Colorado/Montana/Wyoming State Conference NAACP’s policies and procedures, the Complainant agrees to confer with the Committee investigating the complaint within one week from the date of filing of this complaint.  2. This agreement shall constitute an authorization for the NAACP to investigate this complaint when and where the NAACP deems appropriate on behalf of the Complainant(s) and the NAACP.  3. The Complainant(s) understands that this Agreement shall supersede all communications, oral or written, between the Complainant(s) and the NAACP in this matter.  4. The Colorado/Montana/Wyoming NAACP State Conference of Branches shall not be liable or deemed in default for any delay or failure in performance of this Agreement.  5. The complainant(s) agrees that the Colorado/Montana/Wyoming State Conference NAACP will NOT be liable for the consequential damages or any claim or demand of any nature or kind arising out of this Agreement and thus NO action or suit regardless of form, arising out of this Agreement, may be brought against the NAACP, its Committee, or its Officers.  6. The Complainant(s) acknowledges that he/she has read this Agreement and agrees to be bound by its terms.
Please sign by typing your name. *
By typing my name below, I hereby authorize personnel of the Colorado/Montana/ Wyoming State area Conference of the NAACP (President, Legal Redress Committee) to inspect and review any and all records, files, test results, interview notes, memoranda, and any and all other documents pertaining in any fashion to me, including but not limited to school records, medical records, psychological and psychiatric records, and any other records in the possession of any person or agency, public or private. Please supply copies of the original information only, when applicable.
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