The Equal Rights Center: Survey

Complaint Form

Any community member is able to call or use our online form to submit a complaint or question about discrimination. Trained and qualified ERC staff members respond and offer free counseling and paths to resolution. In addition to counseling, the ERC employs a variety of tools to resolve complaints, including: communicating directly with discriminating parties; advocating before administrative agencies; investigating the extent of issues; taking legal actions.
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Name (or Anonymous) and contact information:

Name:

First Required	Last Required

Email:

Street 1:

Street 2:

City/State/ZIP:

City	State	ZIP

"Yes, I would like to receive e-mail and become a free member of The Equal Rights Center"

Yes, I would like to receive postal mail from The Equal Rights Center

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Question - Required - Telephone (day)

Question - Not Required - Telephone (evening)

Question - Not Required - Telephone (cell)

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Question - Required - Summary of Your Complaint (Please describe events and facts in chronological order. Include dates and names of persons.)

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Question - Required - Please read before submitting: I certify that the above information is true. I understand that The Equal Rights Center (ERC) is a private, not-for-profit organization that works to reduce discrimination in housing, employment, public accommodations, and government services by providing confidential and free-of-charge counseling, advocacy, and investigative services. The ERC does not provide legal services or legal advice. If the ERC determines that my complaint has merit, it may take independent action against a party, or refer me to counsel. The ERC will not share your information with any other organization without first obtaining your permission. For more details, please see our Privacy Policy. Date: