COLOR OF LAW CENTER LEGAL REDRESS COMPLAINT OF DISCRIMINATION INTAKE FORM
This form does not guarantee legal representation. The information provided is for evaluation of eligibility only. Civil Complaints Only.
Email *
First Name *
Last Name *
Email Address *
Preferred Mailing Address *
Preferred Phone Number *
Are you a part of a protected class as defined by the Civil Rights Act of 1964 and/or the Americans with Disabilities Act of 1990 *
Required
Are You Contacting Us Regarding Any of the below Active Cases? If not, select "none of the above." *
Type of Discrimination - Select which category you believe resulted in the discriminatory treatment. *
Required
Who discriminated against you? *
Required
What date did the discrimination occur? *
MM
/
DD
/
YYYY
What time did the discrimination occur?                                                 *
Time
:
Provide the name of the person who committed the discriminatory act. If you do not know the person's name, write "not sure." *
HAVE YOU FILED A GRIEVANCE WITH A GOVERNMENT AGENCY? *
Required
HAVE YOU FILED A GRIEVANCE WITH YOUR UNION?
HAVE YOU RETAINED AN ATTORNEY FOR YOUR CASE? *
Required
If you have retained an attorney, please provide the name and contact information of your attorney.
Further Information
How Did You Hear About Us? *
Is there anything else that you think we should know?
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