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Complaint or Grievance Form

Filing a Complaint or Grievance of Discrimination

Please complete information below in order to file an official complain with the NAACP of Garland, TX.

Completing this form does not constitute an official complaint with a legal authority. At this time, the NAACP is only seeking information to assist you concerning this complaint.

If you would rather utilize a paper form, click here to download complaint form; print, complete then mail/fax/email completed form.

Name: *


First	Last

Address: *

Street AddressCityState / Province / RegionPostal / Zip Code

Phone: *

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Area Code	Phone Number

E-mail: *

Are you filing this complaint for someone else? (If yes, please complete the name of the complainant below): *

Yes

No

Name of Complainant: *


First	Last

Address of Complainant: *

Street AddressCityState / Province / RegionPostal / Zip Code

Phone of Complainant: *

-
Area Code	Phone Number

E-mail of Complainant: *

How would you describe the infraction?Discrimination based on:

Bullying based on:

Harassment based on:

Other:

Name of PERSON/AGENCY/ORGANIZATION: *

Agency Address: *

Street AddressCityState / Province / RegionPostal / Zip Code

Agency Phone Number: *

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Area Code	Phone Number

Describe briefly what happened.: *

How and why do you believe that you have been (or someone else has been) unfairly treated? Please be as specific as possible. Include Who, what, dates and times the infractions occurred and where the infractions occurred and who were parties in the occurrence.:

Name any witnesses.Please be as specific as possible. Include Who, what, dates and times the infractions occurred and where the infractions occurred and who were parties in the occurrence.:

How would you like to have this issue resolved? Be specific. *

Have you filed your complaint anywhere else? If so, please describe.: *

Have you notified anyone in the media or written any letters to newspapers, posted information about this complaint on Facebook or any social media? If so, please describe.: *

By checking below, I affirm that I have read and fully comprehend the above charge and accusation that I am filing and further that it is true to the best of my knowledge based on the information that I have obtained. *

I Agree

Please sign and date this complaint. You do not need to sign if submitting this form by email because submission by email represents your signature.: *

Date: *

Word Verification:

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