Section 1 of 1 in this document

Receipt

You will be provided with a Receipt upon submission.

CHARLOTTE-MECKLENBURG COMMUNITY RELATIONS PUBLIC ACCOMMODATIONS / EMPLOYMENT DISCRIMINATION COMPLAINT

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The Complainant named below charges the Respondent (s) named below with a violation of the Charlotte Non Discrimination Ordinance (Chapter 12, Articles II, III & IV, of the Charlotte City Code)/Public Accommodations or Employment Protections.

Preferred Name

Pronouns Used

Phone Number

Emergency Contact for Complainant:

Name

Phone Number

Name

Phone Number

Respondent Name:

Respondent Phone Number

What is the complaint type?

Is the Respondent:

Please explain:

Name and identify other (if any) you believe violated the NDO in this case:

What did the Respondent do?

Please explain:

What kind of business was involved?

Summary of Allegations:

When did the most recent act of discrimination occur?

Have you filed a complaint with any other business, organization, court, or governmental organization?

Yes

I swear or affirm that I have read this complaint (including any attachments) and that it is true to the best of my knowledge information or belief.

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First Name

Last Name

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Receipt

CHARLOTTE-MECKLENBURG COMMUNITY RELATIONS PUBLIC ACCOMMODATIONS / EMPLOYMENT DISCRIMINATION COMPLAINT

The Complainant named below charges the Respondent (s) named below with a violation of the Charlotte Non Discrimination Ordinance (Chapter 12, Articles II, III & IV, of the Charlotte City Code)/Public Accommodations or Employment Protections.

Full Name of Aggrieved Person (Complainant):

Full Address

Emergency Contact for Complainant:

Respondent Address:

Basis for Complaint

Address of the subject property:

Have you filed a complaint with any other business, organization, court, or governmental organization?

Sign Here