Complainant Information
Prefix
First Name
MI
Last Name
Address Line 1
Address Line 2
City
State
New Mexico
Zip
Email
Confirm Email
Phone
Have you filed this complaint with a Federal or State Agency?
Yes
No
I believe I was discriminated against by
Prefix
First Name
MI
Last Name
Organization
Address Line 1
Address Line 2
City
State
New Mexico
Zip
Email
Work Phone
This person is a
Employer (workplace)
Employee (workplace)
Business owner (place of public accommodation)
Employee (place of public accommodation)
Owner (of a home or other residence)
Manager (of a home or other residence)
Employee (of an apartment complex or other residence)
Sales person/Realtor (of a home or other residence)
Who referred you to the Office of Civil Rights and/or ADA Coordinator?
Type of Discrimination
Employment
Housing
Public Accommodations
What basis were you discriminated against?
Race
National Origin/Ancestry
Color
Sex
Physical Disability
Age (Employment only)
Religion
Source of income (housing only)
How were you discriminated against?
Disclaimer
The staff of the Office of Civil Rights and/or the ADA Coordinator strives to maintain the confidentiality of the information obtained during the course of an investigation and in most cases, it will only be divulged on a need-to-know basis. However, some of the records obtained or created during the investigation may be subject to disclosure under the Albuquerque Public Records statute.
Yes
I affirm that I have read the proceeding information and charge(s) and attest that it is true to the best of my knowledge, information, and belief. I have read and understand the confidentiality statement. I hereby give the Office of Civil Rights and/or the ADA Coordinator permission to thoroughly investigate my inquiry. I understand the information gathered will be kept confidential to the extent possible.
Yes