Online Complaint Form — NAACP Bremerton Unit 1134
NAACP Bremerton Unit 1134
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NAACP Bremerton Unit 1134
Meetings
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Contact
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Donate
NAACP Preliminary Complaint Form - Online
Name
*
First Name
Last Name
Email Address
*
Phone
(###)
###
####
Mailing Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Ethnicity/Race
*
Sex
Age
Date of Birth
MM
DD
YYYY
NAACP Member
No
Regular
Life
Silver
Gold
Diamond
Past Member?
Yes
No
Respondent
Party you are filing the complaint against
Respondent Name
First Name
Last Name
Company
if applicable
Respondent Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Cause of Discrimination or Civil Rights Complaint
Race
Color
National Origin
Sex
Age
Marital Status
Height
Weight
Familial Status
Physical or Mental Disability
Arrest Record
Religion
Other
Area of Complaint
Employment
Housing
Education
Public Accommodation
Public Service
Briefly Describe Your Complaint
Have you retained an attorney to handle this matter?
Yes
No
Has a complaint been filed with...
Department of Civil Rights (MDCR)
Equal Employment Opportunity Commission (EEOC)
Human Rights Department
Other
Have you tried to discuss/resolve this problem with the Respondent?
Yes
No
What is your desired outcome?
Thank you! We will follow up with you as soon as possible.