Submitting this complaint questionnaire does not constitute the formal filing of a discrimination charge, but it serves to preserve all rights under the statute of limitations. The formal filing will take place when we review your questionnaire and hold an intake interview with you at the OHR Office.
1. Complainant Information
How do you prefer we contact you?
ARE REPRESENTED BY COUNSEL, PLEASE PROVIDE THE FOLLOWING:
2. RESPONDENT INFORMATION
3. BASIS OF COMPLAINT
Do you feel you were discriminated against because of your: (Please check appropriate box)
5. Issue of Complaint
What action was taken that made you feel you were treated differently? *
Date of Alleged Incident:
Person who denied your service request (If known)
7. Referral Information
How did you hear about the DC Office of Human Rights (check all that apply)?