Covid-19 Discrimination Report

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Report Discrimination
The NAACP wants to track possible civil rights violations individuals experience during the Covid-19 pandemic.
Please tell us about your experience using the form below.

Contact Information

* Indicates required field

Name *

First

Last

Email *

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Demographics

Gender *

Male Female Other Prefer not to say

Age Range *

0-17 18-29 30-39 40-49 50-59 60-69 70-79 80+

Race *

American Indian or Alaska Native Asian Black or African American Hispanic of Latino Native Hawaiian or other Pacific Islander White

Check all that apply

Discrimination

What is your issue or concern about? *

Covid-19 Testing Education Unemployment Child Care Small Busniess Support Law Enforcement/Profiling/Use of Force Inmate Support Rent/Mortgage Voting/Voter Suppression Other

If other, please explain below *

Is this a Group or Individual Concern? *

Group Indivdual

Please explain the issue or concern *

Is your issue or concern tied to a specific company or organization? *

Yes No

What actions have you take to address your issue or concerns? *

Submit

Powered by The Arlington TX NAACP

HOME
Become A Member
UPCOMING EVENTS
Donate!
Voter Info
Protect the Vote

Report Discrimination The NAACP wants to track possible civil rights violations individuals experience during the Covid-19 pandemic. ​Please tell us about your experience using the form below.

Contact Information

Demographics

Discrimination

Report Discrimination
The NAACP wants to track possible civil rights violations individuals experience during the Covid-19 pandemic.
Please tell us about your experience using the form below.