Civil Rights & Employment Alert Us Form

Please use the form below if you want to share specific information with us related to our Civil Rights & Employee Discrimination practice area. You may choose to remain anonymous (see below), but we will not be able to respond unless you enter at least your e-mail address.

E-mail Address:

Please describe who you believe has violated your civil rights:

Please indicate which classification was used in a discriminatory manner, i.e., was it discrimination on the basis of race, gender, religion, age, or disability.

Race
Gender
Religion
Age
Disability

If you believe you have been discriminated against in employment, was it through any of the following -- termination, refusal to hire, unequal pay, unequal opportunity for advancement, sexual harassment, retaliation, or failure to make reasonable accommodations? Please explain.

Termination
Refusal to Hire
Unequal Pay
Unequal Opportunity for Advancement
Sexual Harassment
Retaliation
Failure to make reasonable accommodations

Do you know other individuals with similar circumstances? Please explain.

Please provide any additional comments:

If you would like us to contact you, please fill in the following information. This information is optional, but an e-mail address at least is necessary for us to respond.

Name:

Street Address:

City/State/Zip:

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