DISCRIMINATION COMPLAINT FORM | NAACP West Volusia Branch

The Mission of the National Association for the Advancement of Colored People is to secure the political, educational, social, and economic equality of rights in order to eliminate race-based discrimination and ensure the health and well-being of all persons.

DISCRIMINATION COMPLAINT FORM
Completing this form does not constitute filing an official complaint with a legal authority. At this time, the NAACP is only seeking information to assist you concerning your complaint. We only address incidents that occurred in Volusia County.

First Name(Required)

Last Name(Required)

Best phone number(Required)

Email(Required)

Indicate nature of the discrimination (check all that apply) and include the date of incident:

Date of Incidence:(Required)

Add any pertinent information here, upload any supporting documents below.

Upload for supporting documents

Drop files here or

Max. file size: 6 GB.

What have you done to resolve this complaint?

Agency or Court

Date Filed(Required)

Contact Person

Phone

Street Address

City

State

Zip Code

Email

Agency or Court

Street Address

City

State

Zip Code

Phone

When do you expect to file?

Date of complaint(Required)

Briefly describe your past complaint(s)

What was the outcome of the complaint(s).

Agreement & Signature of Complaintant

By adding my name and the date, I affirm that I consent to this electronic signature being legally binding, authenticating my identity, and confirming my agreement to these terms

Signature(Required)

Date(Required)

Note: The filing of this complaint does not obligate the NAACP in any matter. It is your responsibility to pursue your complaint in the appropriate manner. Also, filing a complaint with the Volusia County Branch of the NAACP does not prevent you from filing with the EEOC or other Federal agencies or Courts.