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DISCRIMINATION COMPLAINT FORM

Submitted to:
NAACP Branch #1111

3065 N. Rancho Dr., Ste. 154

Las Vegas, NV 89130


Office Hours:
11:00AM PST to 4:00PM PST

Monday through Friday

 

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Once submitted your responses will be forwarded to our representatives, via email, which will document the date and time of your submission. If you wish to follow-up with a representative via telephone, please feel free to call (702) 638-1300.

COMPLAINT FILING PROCEDURES

Filing a Complaint

All complaints filed with the NAACP Branch #1111, Las Vegas must be submitted through the official “Discrimination Complaint Form.”  This process ensures logging and timely processing of your complaint. You may attach additional documentation if needed.

 

HOW TO REQUEST A COMPLAINT FORM:

 

Complainants also have the option of coming to the NAACP Branch #1111, Las Vegas Office and pick up a complaint form and fill it out in the office.  

 

 

THE USE OF THE OFFICIAL COMPLAINT FORM:

 

The NAACP requires that all complaints be submitted on the official “Discrimination Complaint Form.”  Please provide the facts surrounding your complaint in a condensed manner. It is highly advised that you add any additional supporting documents and/or statements in a series of events leading up to the reason for the complaint.  

 

GENERAL GUIDELINES:

 

Please ensure that your hand-writing is legible and that each page of your complaint is numbered.

 

IF YOU ELECT TO COMPLETE A HARD-COPY
“Discrimination Complaint Form”:  

 

Mail the completed form and any documentation of your claim(s) to:

 

NAACP Branch #1111

3065 N. Rancho Dr., Ste. 154

Las Vegas, NV  89130

CONSENT FORM FOR NAACP ASSISTANCE

I                                                                          hereby authorize NAACP Branch #1111, Las Vegas to investigate my complaint and render me whatever assistance it deems necessary and appropriate to resolve my problem.  

 

I understand that the NAACP Branch #1111, Las Vegas by its willingness to review my complaint is not serving as legal counsel or a personal representative in the matters I intend to bring to their attention by filing the “Discrimination Complaint Form.”

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If you are currently represented by legal counsel you must submit a formal letter from your attorney acknowledging their agreement with the NAACP Branch #1111, Las Vegas investigating your complaint, there is no exception to this policy.  Your attorney may contact the NAACP Branch #1111, Las Vegas for additional clarification.

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Have you filed a complaint of any type on this matter prior to filing your complaint with the NAACP Branch #1111, Las Vegas?

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If this is an employment related complaint, please provide the following information.

If this is an employment related complaint and you are a member of a union, please provide the following information.

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Who are the principal parties who were responsible for the discriminating behavior?

Include any documentation, which supports your complaint

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ACKNOWLEDGEMENT

 

The NAACP Branch #1111, Las Vegas makes every effort to provide some degree of assistance to its members.  If you are not now a member, we invite you to become a member. We will be glad to forward a membership envelope for your convenience.  The strength and future of the NAACP Branch #1111, Las Vegas rests in the hands of our concerned citizens.

 

By electronically submitting this form, I affirm that the statements that I have made are accurate and true to the best of my knowledge and belief.  Furthermore, by electronically submitting this form, I am requesting the assistance of NAACP Branch #1111, Las Vegas in seeking remedy to the situation described herein.  

 

I further authorize the officers of the NAACP Branch #1111, Las Vegas to have access to information and documents, which are relevant to my claim of discrimination as articulated herein.  

 

I further acknowledge that once a referral is made to another agency, community agency, or private attorney, the NAACP Branch #1111, Las Vegas is NOT RESPONSIBLE for the handling of this matter.  In fact, I further acknowledge that by electronically submitting this document, I am agreeing to hold the NAACP Branch #1111, Las Vegas harmless, for any and all damages arising as a result of my case being mishandled, negligently handled, or improperly handled in any way.

 

I further acknowledge that by electronically submitting this document, I have no expectation that the NAACP Branch #1111, Las Vegas or the National Office of the NAACP to provide legal representation on this matter.

 

By electronically submitting this document, I hereby authorize the NAACP Branch #1111, Las Vegas to investigate my complaint and take any steps necessary to resolve the complaint if it meets the requirements as outlined by the National, Regional, and Local NAACP, to include contacting my employer, lawyer, agent, or any parties associated with my complaint.

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