Form Title

File a Discrimination Complaint

Filing Type
The person making the complaint of discrimination.
Name information
*
*
Address Group: Your Address
*

City/State/Zip
*
*
*
*
*
Preferred Communication
*
Attorney Hiring Information
Note: You do not need an attorney to file a complaint.
Complainant/Attorney's Contact Information

Complainant's Contact Person

Attorney Contact Information

Name someone outside of your household who would know how to contact you. The Department of Civil Rights will only contact this person if we are unable to reach you at the contact information you provided above.
Name information
Address Group: Complainant's Contact Person
City/State/Zip
Phone
Email

Respondent

The employer, housing provider, business, or City of Madison agency you believe discriminated against you. Note: if you wish to file a complaint against more than one Respondent, please submit an additional form. One Respondent can only be investigated per complaint. If you have questions, please call us at (608) 266-4910.
*
Address Group: Respondent's Address
*
City/State/Zip
*
*
*
Phone
*
Phone

Complaint Information

This complaint is about
*
*
*

*
*
What do you hope to get out of this process?
You will have the opportunity to submit electronic documentation of your complaint at a later time.
*
Signature Information
*

By signing below, I hereby agree to comply with the Equal Opportunities Commission Rules and to fully participate in the investigation of this complaint. I am aware that failure to do so may result in the dismissal of the case.

Date Signed
CCP Use
Submit
Signature Pop-up
Guardian/minor Pop-up