Community Relations

NDO@charlottenc.gov

700 Parkwood Road. Charlotte NC, 28203

704.336.5160

Receipt

You will be provided with a Receipt upon submission.

CHARLOTTE-MECKLENBURG COMMUNITY RELATIONS PUBLIC ACCOMMODATIONS / EMPLOYMENT DISCRIMINATION COMPLAINT

The City of Charlotte does not discriminate on the basis of disability. We will provide auxiliary aids and services, written materials in alternative formats, and reasonable modifications in policies and procedures to persons with disabilities upon request. To make a request, please email infocrc@charlottenc.gov or call 704-336-5160.

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.

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Emergency Contact for Complainant:

Name

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Name

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Respondent Name:

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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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