Human Relations Commission: Discrimination Pre-Interview Form

 Step 1 of 1

This form is used by the Evansville-Vanderburgh County Human Relations Commission (HRC) as a means of obtaining basic information from you.

IMPORTANT!!

Please note: Submitting out this form does not constitute a formal complaint. After you submit this form and the Human Relations Commission is able to review it, an HRC investigator will contact you to explain the process and gather further information regarding your allegations. Following this initial interview, if you decide to file a complaint, the investigator will assist you with the next steps.

Please fill out the form below

* Denotes a required field

Complainant

 
 
 
 
ZIP 
-
Second portion of ZIP Code is optional.
Phone Number 
-- ext
Alternate Phone 
-- ext
*
Date of Birth 
 Date of Birth

Please Provide the name of someone not living in your home who knows where you are at anytime

 
 
 
 
ZIP 
-
Second portion of ZIP Code is optional.
Phone 
-- ext
Alternate Phone 
-- ext
 

Nature of Inquiry

The alleged discrimination occured in: 
Date of Incident/Discrimination 
 Date of Incident/Discrimination
Please provide the Reason for the difference in treatment 
Please answer the following:
 
If charging an Employer with Discrimation, are you currently employed with them?*
If charging a Housing Provider with discrimination, are you facing eviction?*
 
Please click Submit below when finished to send your inquiry to our offices.
*