Discrimination Complaint Form

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NOTE: THE LEGAL REDRESS COMMITTEE CANNOT PROVIDE LEGAL ADVICE OR REPRESENTATION. Committee members are volunteers, often without legal backgrounds or experience. We will investigate all complaints of discrimination that took place within Fairfax County, and can provide non-legal support to complainants (resources, help writing emails or letters, attendance at meetings, etc.).

NOTE: A Google account is NOT required to submit this form.

Email *

Name *

Phone Number *

Preferred Method of Contact

Phone

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Date of Incident *

YYYY

Location of Incident *

NOTE: If your incident did not take place in Fairfax County, your information will be sent to the appropriate NAACP branch.

Discrimination Type *

Workplace

Housing

Police Misconduct

Racial Profiling

Voting Rights

Education

Other:

What happened? *

Please provide as much detail as possible.

Have you retained a lawyer regarding this incident? *

Yes

If the answer to the previous question was "yes," please provide the name and contact information of your attorney.

Do you have any scheduled hearings/meetings/appearances related to your complaint? If so, please tell us what and when. *

Are there any witnesses or people we should talk with regarding your complaint? If so, please provide their names and contact information. *

What do you hope the Fairfax County NAACP can do for you regarding this matter? *

Send me a copy of my responses.

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