Complaint Form

After submitting your complaint, call our office to schedule an appointment. Our hours of operation and contact information is below.

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Date of service*

Are you a member of the NAACP?*

Are you registered to vote?*

First name, last name and home mailing address*

Phone Number*

Email*

Provide the full name of the company, business, employer, etc., (hereafter called the "Respondent") that you have a complaint against.**

Briefly explain your primary issue in two sentences below.*

What type of discrimination case are you pursuing (Criminal Justice, Police Misconduct, Housing, Education, Employment, Religion, Healthcare, Etc.)*

Have you tried to resolve your complaint through a formal or informal grievance process? If yes, with whom?*

Have you contacted any other organizations for assistance? If so, please list them here.*

I hereby direct and release to my authorized Dayton Branch NAACP Representative any and all information deemed confidential that will assist my case.

Supporting Documentation

Max. file size: 100 MB.

Phone

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Civil and Human Rights Organization

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NAACP Dayton Headquarters

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