Complaint Form

After submitting your complaint, one of our investigators will contact you within 2 business days. Our office hours are Monday through Friday, 10 a.m. until 2:00 p.m.

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This field is for validation purposes and should be left unchanged.

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: 512 MB.

Civil and Human Rights Organization

Advocate and Information Center!
NAACP Dayton Headquarters

915 Salem Avenue
Dayton, Ohio 45406

(937) 222-2172

Mon - Fri: 10:00 AM - 2:00 PM
Sat & Sun: Closed

Evaluation Form

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Complaint Form

Civil and Human Rights Organization

Evaluation Form

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