[DC GOVERNMENT] Complaint of Discrimination District of Columbia Department of Energy and Environment

Complaint of Discrimination District of Columbia Department of Energy and Environment

If you believe that you have been discriminated against with respect to a DOEE program or activity, you may file a complaint of discrimination by completing this form or by sending your complaint to nondiscrimination.doee@dc.gov. Please include your contact information and a statement of your complaint.

Prefix

Mr.

Mrs.

Ms.

Phone Number

Age

Discrimination Based On (Please check any and all applicable)

Age

Color

Disability

National Origin

Race

Religion

Retaliation

Sex

Other

If other, Please explain

Earliest Date Discrimination Took Place

Latest Date Discrimination Took Place, or indicate if ongoing

The particulars of the discrimination are:

I declare that the above is true and correct (selecting "Yes" below serves as your electronic signature for this form)

Yes, I declare

No, I don't Declare

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