The Metropolitan Human Relations Commission
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The alleged discrimination occurred in
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Employment
Housing
Public Accommodation
School
Full Name (including middle initial)
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Permanent Address
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City
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State
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Zip Code
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Phone
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Work Phone
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Cell Phone
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Email
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Date of Birth
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Please provide the name of someone not living in your home who knows where you are at anytime
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Phone
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Address
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City
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State
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Zip Code
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Relationship
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PLEASE PROVIDE the REASON for the difference in treatment: (check all that apply)
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Race or Color
National Origin
Ancestry
Place of Birth
Religion
Age (Employment Only)
Disability
Pregnancy
Equal Pay Issue
Sex
Retaliation
Familial Status(Housing only)
Sexual Orientation
Sexual Harassment
Date of Incident/Discrimination
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I learned about this agency by
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If you are charging an Employer with discrimination, are you currently employed with them?
Yes
No
Does Not Apply
If charging a Housing Provider with discrimination, are you facing eviction?
Yes
No
Does Not Apply
Would you like an interpreter?
Yes
No
If Yes, what language?
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