File a Discrimination Complaint | Civil Rights, City of Madison, Wisconsin

Complainant

The person making the complaint of discrimination.

First Name *

Middle Initial

Last Name *

I don’t have a permanent address.

Care of

Address *

City *

State *

Zip Code *

Phone *

Email *

Confirm Email

Preferred Communication

I prefer to receive written communication from the Department of Civil Rights through: *

Mail

I have hired an attorney to assist with filing this complaint.

Note: You do not need an attorney to file a complaint.

Complainant's Contact Person Parent/Guardian Contact

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.

First Name

Middle Initial

Last Name

Company Name

Address

City

State

Zip Code

Phone

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.

Name of Employer, Housing Provider, Business, or City of Madison Agency *

Address *

City *

State *

Zip Code *

Phone *

Complaint Information

This complaint is about *

Employment

City Services

Housing

Public Accommodation

When did the most recent incident of discrimination happen? (Approximate guess is OK.) *

Where did the incident of discrimination occur? (City/State) *

What negative treatment or action did you experience? *

Explain how you believe the negative treatment or action you received is related to each of the protected classes you selected.

(Minimum 35 characters)

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.

I am 18 years of age or older. *

Signature *

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. Additionally, by signing below I hereby verify that the facts and allegations are true to the best of my knowledge.

Date Signed

CCP Use Only (Organization):