Civil Rights Practice Center

Civil Rights Contact Form

Name

Email Address

Phone Number

Business Phone

Cellular or Pager

Address

City

State

Zip

Does your situation involve any of the following issues?
Age Discrimination
Sex Discrimination
Race Discrimination
Religion Discrimination
National Origin Discrimination
Disability Discrimination
Freedom of Speech
Freedom of Religion
Freedom of the Press
Due Process
Search and Seizure
Right to Privacy
Education Discrimination or Access
Other

Please briefly explain your situation.

Have you contacted any government agencies regarding your situation?
Yes No 

If so, what agency?

How did the agency respond?

If the situation involves educational discrimination, have you filed a complaint with the school?
Yes No 

If the situation involves employment discrimination, have you filed a complaint with the employer?
Yes No 

Do you have any additional information you would like to share?

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