Please note that we will not process your application unless all questions are completed, along with a one-part summary of the alleged discrimination that occurred. Incomplete applications will not be investigated.

NAACP El Paso Branch # 6175 Civil & Human Rights Complaint Intake Form

Last Name

Address

Street Address

City

State

Country

Postal code

PLEASE NOTE THAT WE WILL NOT PROCESS YOUR APPLICATION UNLESS ALL QUESTIONS ARE COMPLETED, ALONG WITH A ONE-PART SUMMARY OF THE ALLEGED DISCRIMINATION THAT OCCURRED. INCOMPLETE APPLICATIONS WILL NOT BE INVESTIGATED.

Attorney's Phone #

Please select all that may apply (please submit copies with form)

How were you discriminated against? *

Who discriminated against you? Include name(s), race, and gender of each. *

Name
Race
Gender

Where did the discrimination take place *

Address
City
State

What was the effect of the discrimination on you? *

To date, what actions have you taken so far? *

Have you filed a complaint with or notified any other Agency, organization or individual regarding this matter? *

Yes

No

What actions, if any, were taken in response to the complaint or notice of concern? *

Who took these actions? *

When were these actions taken? *

What would you like the NAACP El Paso Branch to do for you regarding your allegation of discrimination? *

Release of Liability

I affirm that the statements that I have made above are accurate and true to the best of my knowledge and belief. I hereby request the assistance of the NAACP El Paso Branch in seeking a remedy to the situation described above. I hereby authorize the officers of the NAACP El Paso Branch to have access to information and documents which are relevant to my claim of discrimination described above.

I understand that once a referral has been made to a volunteer, community agency, or private attorney, the NAACP El Paso Branch WILL NOT BE RESPONSIBLE for handling this matter. In fact, I further understand that by signing this document, I am agreeing to HOLD the NAACP El Paso Branch harmless for any and all damages arising as a result of my case being mishandled, negligently handled, or improperly handled in any way.

Section 704 (a) of the Civil Rights Act of 1964, (as amended), Section 4 (d) of the Age Discrimination in Employment Act of 1967, (as amended), and various other civil rights laws make it an unlawful employment practice for an employer; employment agency; or labor organization to discriminate against employees, applicants for employment, member or applicant for membership, because the employee, member or applicant has opposed an unlawful employment practice, made a charge, testified, assisted, or participated in any manner in an investigation, proceeding or hearing. All legal claims have deadlines. For some civil rights violations, you may be required to file a notice or pursue options with a government agency before you can file a lawsuit in court. If you do not comply with time deadlines or notice requirements, you could be legally prevented from pursuing your claim in court. Contacting the NAACP for assistance does not stop these deadlines or eliminate the need to file notices. If you have an urgent need or must meet a deadline, contact a private attorney, your local public defender, or your state’s bar association. DO NOT WAIT for a response from the NAACP. (See links below) Employment: https://www.twc.texas.gov/jobseekers/how-submit-employment-discrimination-complaint Housing: https://www.twc.texas.gov/partners/how-submit-housing-discrimination-complaint#complaintRequirements Election/Voting: https://www.sos.state.tx.us/elections/forms/complaintform-sos.pdf Education: https://tea.texas.gov/about-tea/contact-us/complaints/tea-complaints-management Public Accommodations: https://www.ada.gov/filing_complaint.htm Law Enforcement: https://www.tcole.texas.gov/content/complaint-procedures

COMPLETION OF THIS FORM

Completing this form does not constitute filing an official complaint with a legal authority. At this time, the NAACP El Paso Branch is ONLY seeking information to assist you concerning this complaint. Please send a “Confidential” labeled email of this form to [email protected] or mail this form and copies of sustaining documents in an envelope marked “Confidential” to: NAACP EL Paso Branch Post Office Box 4455, El Paso, Texas 79914

Address:
Phone: