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
Other
Other
What basis were you discriminated against?
Race
National Origin
Sexual Orientation
Color
Sex (including pregnancy)
Ancestry
Gender Identity
Disability
Age
CROWN Act (hair, headdress)
Religion
Income Discrimination
Other
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