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Please detail incident report in the section below.
Please provide the location of incident.
Please check all options that are applicable to your incident.
If you choose Other Protected Status please list that discrimination
Please detail the incident
Please put witness name and best number to contact this person
Please one option only.
If complaint form is being prepared by someone who was not involved in the dispute, please fill out the requested information below. If complainant is completing this form, they are exempt from this section.
Please type name in box provided
This field is not part of the form submission.
* indicates a required field