Pre-Complaint Questionnaire - Public Accommodation

Step 1 of 5

  • The information requested on this form will assist the Equity and Engagement Department in helping you. There is no guarantee that the information submitted will result in an investigation. Please check or answer only those questions that apply.
  • MM slash DD slash YYYY
  • :
  • I wish to complain against
    (State full legal name of the person, place of public accommodation or organization that you believe discriminated against you in public accommodations)
  • Questionnaire

  • Check all appropriate boxes
  • By law, no other category can be investigated. Please check which categories, if any, apply to your situation.
    For having assisted in an investigation of discrimination or for openly opposing unlawful discrimination based upon any of categories listed above.
  • If you checked physical or mental disabilities, please explain how the Respondent became aware of your disabilities