Complaint Form Complaint Form Completing this form does not constitute filing an official complaint with a legal authority. At this time the NAACP Boulder County Branch is only seeking information to assist you concerning this complaint. * * Accept Area of Discrimination * Race Age Gender Orientation Religious Disability Veteran Housing Lending other Where did this take place? * Boulder County Colorado other How were you mistreated, harassed, or discriminated against? * By whom were you mistreated, harassed, or discriminated against? * Full Name * Race/Ethnicity * Email Phone * By submission of this Complaint, I affirm that the statements that I have made above are accurate and true to the best of my knowledge and belief. I hereby request the assistance of the NAACP Boulder County Branch in seeking a remedy to the situation described above. I hereby authorize the officers of the NAACP Boulder County Branch to have access to information and documents, which are relevant to my claim of discrimination described above. I understand that once a referral to a volunteer, community agency, or private attorney has been made, the NAACP Boulder COUNTY BRANCH WILL NOT BE RESPONSIBLE for handling this matter. In fact, I further understand that by submitting this document, I am agreeing to HOLD the NAACP Boulder COUNTY BRANCH harmless for any and all damages arising as a result of my case being mishandled, negligently handled, or improperly handled in any way. * Accept If you are human, leave this field blank. Submit
