Home
About
About
Committees
Membership
Events
2023 Freedom Fund Fundraising
Our Scheduled Events
Past Events
Recent Events Photo Gallery
Archived Events Photo Gallery
DONATION Forms
Help people affected by Hurricane Ian
Disaster Relief -Help people affected by disasters great and small.
Where It Is Needed Most – Support of the humanitarian mission of the South Dade Branch NAACP
Women in NAACP – Support the important work for women and our entire community
Scholarship Fund
Shop
News
NAACP News
NAACP Newsletter
Resources
Membership Form
Complaint Form
Contact Us
0 items
Discrimination Complaint Form
South Dade Branch South Dade NAACP
Discrimination Complaint Form
Please enable JavaScript in your browser to complete this form.
–
Step
1
of 3
DISCLAIMER: The South Dade Branch of the NAACP does not provide legal assistance and is not acting as your attorney in this matter.
Contact Information
Name
*
First
Last
Email Address
*
Cell Phone Number
*
Home Phone
*
Work Phone Number
Zip Code
Date / Time
Date
Time
Next: Discrimination Information…
Click Continue to provide information on your discrimination Complaint…
Continue
Please check your type of complaint:
Choose a Membership Plan
Police Misconduct
Education
Employment
Housing
Banking & Finance
Government Agency
Race Relations
Veterans’ Affairs
Print & Electronic Media
Stage & Theatre
Communications
Other
Tell Us About Your Complaint.
Do you already have an attorney working on your behalf?
*
No
Yes
Choose one
If yes, please complete the following: Do you authorize your attorney to communicate with a representative from the South Dade NAACP? Please initial here:
*
Clear Signature
Attorney Information
Name (copy)
*
First
Last
Address
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Has a lawsuit been filed?
*
No
Yes
Choose one
When was it filed?
In which court?
Do you wish to file a civil or criminal appeal?
*
No
Yes
Choose one
Do you have financial resources?
*
No
Yes
Choose one
Have you filed a complaint with any governmental agency?
*
No
Yes
Choose one
If yes, when and with which agency?
Employment Complaints
Is this an employment complaint, please provide the following information:
*
No
Yes
Choose one
Employer or former employer:
*
Supervisor:
*
Address
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Employment Complaints
Has a grievance been filed through your union?
*
No
Yes
Choose one
Union:
Business Agent/Steward
Local Number:
Union Phone Number:
Complaint Sunmmary
Provide additional information regarding your incident
Provide additional information regarding your incident
Comments
Next: Complete & Submit (copy)
Click continue to complete your discrimination Complaint information and submit your form online.
Previous
Continue
Acknowledgement & Form Submission
If you are not a member and you’re interested in becoming a member of South Dade NAACP, please complete our online form at: https://southdadenaacp.org/membership-form/
I,
*
do hereby authorize the South Dade branch of the NAACP to investigate my complaint and to take any steps necessary to resolve it. I understand that the South Dade Branch of the NAACP does not provide legal assistance and is not acting as my attorney in this matter.
Complaintant's Signature
Clear Signature
Print Full Name
Date / Time
Date
Time
Witness Signature
Clear Signature
Date / Time
Date
Time
Upload any additional supporting documentation here
Click or drag files to this area to upload.
You can upload up to 3 files.
Files supported are: .pdf, .docx, .doc, .jpeg, .png, .mp4 (file size limit is 5 MB)
Submit
