Are you a member of the NAACP?
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Yes
No
If yes, what branch are you a member of?
Date
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MM
DD
YYYY
Name
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First Name
Last Name
Phone
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(###)
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####
Email
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Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Are you currently represented by an attorney?
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Yes
No
Please list entity against which you are filing complaint (select all that apply)
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Indicate type of discrimination (select all that apply)
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How were you discriminated against?
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Be specific about the details. Explain what was said or done.
Who discriminated against you?
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Include names, race, gender, etc.
Did anyone witness the discrimination that took place?
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If yes, Include name, phone, and address. If no, indicate N/A.
What was the effect of the discrimination on you?
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Be specific about the details. Explain what consequences you faced afterwards.
Were others treated differently than you were treated?
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Yes
No
If yes, please name the individuals and describe the difference in treatment and circumstances.
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If others were not treated differently, indicate N/A.
When were these actions taken?
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MM
DD
YYYY
What would you like the NAACP to do for you regarding your allegation of discrimination?
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Be specific about the details.
Have you filed any of he following? (select all that apply)
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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 Texas NAACP State Conference of Units in seeking a remedy to the situation described above. I hereby authorize the officers of the Texas NAACP State Conference of Units to have access to information and documents which are relevant to my claim of discrimination described above. I understand that the NAACP is not a law firm and cannot provide me with legal advice or legal representation. Although some of its members and volunteers are lawyers, they represent the NAACP and not me personally. I understand that once a referral has been made to a volunteer, community agency, or private attorney, the Texas NAACP State Conference of Units WILL NOT BE RESPONSIBLE for handling this matter. In fact, I further understand that by signing this document, I am agreeing to HOLD the Texas NAACP State Conference of Units harmless for any and all damages arising as a result of my case being mishandled, negligently handled, or improperly handled in any way.
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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
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