THIS IS NOT A FORMAL COMPLAINT OF DISCRIMINATION

The form below is not a complaint form but an intake questionnaire. Our office will review the information you submit in order to determine if your complaint falls within our jurisdiction. A formal complaint is filed when a staff member has drafted a charge form and your signature on the form has been notarized.

For further information about filing a complaint, please review our FAQs and Guidelines for the Complainant.

You may fill out this form or contact our office at (651)266-8966 to inquire if your complaint is one which our office could investigate.

If the act of discrimination in question took place approximately one year ago, you should call our office immediately to avoid further delay. Please note our office cannot investigate acts of discrimination that are over one year old.

Once you have submitted this form online, a Human Rights Specialist will review the information provided and will be in touch with you. If you have not heard from our office within one week regarding your submission, please do not hesitate to contact us at (651)266-8966 or via email

Your Contact Information

Name:*

Address:*

Phone Number*

City, State and ZIP*

Email Address *

Please select the box(s) that best fit your particular case.
On what basis do you believe you were discriminated on? (required)

Age Ancestry Color Creed Disability Familial Status

National Origin Public Assistance Race Religion Sex Sexual or Affectional Orientation

Please select the box(s) that are appropriate for your particular case.
In what area were you discriminated against?

Business, Credit or other Prohibited Practice Education Employment

Public Accommodations Public Services Real Property/Housing

Contact Information of who discriminated against you.

Name (Business or Individual):*

Address (No P.O. Boxes):*

Phone Number

City, State and ZIP*

Please provide a Brief Description of the act in which you believe you were discriminated against.

Be sure to include WHEN and WHERE the act took place.*

Date discrimination first occurred:*

Date of most recent incident:*

Is the discrimination ongoing?*

Yes

No