Human Rights Intake Questionnaire

Human Rights Intake Questionnaire

Note: 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

Human Rights Intake Questionnaire Form

Personal Information
Information About the Incident
Contact Information of who discriminated against you
Incident
Be sure to include WHEN and WHERE the act took place.