First Name (required)
Last Name (required)
Email Address (required)
Mailing Address (required)
Phone Number (required)
City, State and Zip (required)
What Was the Cause of the Discrimination?
What date did the discrimination occur?
What time did the discrimination occur?
Provide sufficient details explaining the incident of discrimination and your request of the NAACP.
Who discriminated against you?
Provide the name of the person that acted against you.
Provide a phone # to contact the person that acted against you.
Have You filed a Grievance with a government agency?
Have You filed a Grievance with your union?
If you have retained an attorney, please provide the name of your attorney.
If you have retained an attorney, please provide the Phone # for your attorney.
Are you seeking support for yourself as an individual or support in addressing the widespread issue affecting multiple members in the Fort Worth - Tarrant County community?
I am seeking support for myself as an individualI am seeking support in addressing the widespread issue
Are you a member of the NAACP?
If you are a member of the NAACP, please provide your Membership # and Branch of Affiliation.
By checking below, I affirm that I have read and fully comprehend the above charge and accusation that I am filing and further that it is true to the best of my knowledge based on the information that I have obtained.