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285 N. 7 Hills Road
O’Fallon, Illinois 62269
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Legal Redress Application

This form is for filing a complaint based on race, color, religion, origin, sex, age, or handicapped status. Completing this form does not constitute filing an official complaint with a legal authority. Currently, The NAACP is only seeking information to assist you concerning this complaint.

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Name

First

Last

Street Address

Single Line Text

City

State / Province / Region

Postal Code

Phone Number

Email

Confirm Email

Description Of Complaint

Type of Discrimination (Please check all that apply.)

Race
Religion
National Origin
Sex
Age
Handicapped Status
Other

If other, please describe.

Who discriminated against you?

Address of Discriminator

Single Line Text

City

State / Province / Region

Postal Code

Are there other discriminating parties?

other a City

Have you ever filed a complaint with any governmental agency(ies)?

Yes
No

If so, which agency(ies)?

Have you ever filed a grievance with your union?

Yes
No

Name of Local and Representative:

First

Last

Address

Single Line Text

City

State / Province / Region

Postal Code

We envision an inclusive community rooted in liberation where all persons can exercise their civil and human rights without discrimination. We are committed to a world without racism where Black people enjoy equitable opportunities in thriving communities.

JOIN THE NAACP

Contact us

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Address:
689 Scot Troy Road
O'Fallon, Illinois 62254

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Phone: (618) 632-6542

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