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2019 ACT-SO REGISTRATION FORM
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Filing a Complaint or Grievance of Discrimination
Please complete information below in order to file an official complain with the NAACP of Arlington, 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, please see the document below the electronic form and print, complete then mail/fax/email completed form.
See connect link.
*
Indicates required field
Name
*
First
Last
Email
*
Phone Number
*
Home Address
*
City, State and Zip
*
What Was the Cause of the Discrimination?
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RACE
AGE
SEX
NATIONALITY
GENDER
RELIGION
HANDICAPPED STATUS
OTHER
Who or What Discriminated Against You?
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Was it a business? An Individual? An Organization? A Union? A Government Agency? Etc.
Have You Filed A Grievance Anywhere Else? Such as a Law firm or Government Agency? If so, whom?
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If Employment Related, Have You Filed a Complaint With Your Union? (N/A if doesn't apply)
*
Union Rep's Contact Number (N/A if doesn't apply)
*
If You Answered Yes to the Last Question, Who is Your Representative and What is Their Contact Information? (N/A if doesn't apply)
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Have You Retained an Attorney? (N/A if doesn't apply)
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Attorney's Contact Number (N/A if doesn't apply)
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Attorney's Address (N/A if doesn't apply)
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What Is The Date That The Discrimination Occurred or the Most Recent Date if it is Continuous?
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Explain Below What Has Occurred for you to File A Grievance of Discrimination?
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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.
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I agree
DATE
*
Submit
HOME
Committees
ACT-SO 2019
>
2019 ACT-SO REGISTRATION FORM
Legal Redress
Membership Committee
Education Committee
Political Action
Youth Council
Health Committee
Veterans' Affairs
Become A Member
BIDDING OPPORTUNITIES
File a Complaint
NewsRoom
Media Contacts
Contact Us
Volunteering
COVID-19
COVID-19 Resources
Covid-19 Discrimination Report
NAACP Response to COVID-19
Become A Member -Copy