Submit a Discrimination Inquiry
This form will be submitted to the Office of Civil Rights and the City of Albuquerque ADA Coordinator. These offices will work together to review your inquiry. If your situation does not qualify for investigation by us, we will refer you to another agency for help
Fields with an asterisk (*) are required.
Who referred you to the Office of Civil Rights and/or ADA Coordinator?
Complainant Information
Prefix
First Name
MI
Last Name
Address Line 1
Address Line 2
City
State
New Mexico
Zip
Email
Confirm Email
Cell Phone
Required
Type of Discrimination
Employment
Housing
Public Accommodation
Commercial Space
See definitions for the discrimination terms on this form.
Required
What was the discrimination based on? (Select all that apply)
Age
Color
Race-Related Hairstyle / Cultural Headdress
Disability
Gender
Gender Identity
National Origin or Ancestry
Pregnancy or condition related to pregnancy or childbirth
Race
Religion
Sex
Sexual Orientation
Source of Income (Housing Only)
See definitions for the discrimination terms on this form.
Required
How Were You Discriminated Against?
Enter information about the individual or organization you believe discriminated against you.
Discriminator's Prefix
Discriminator's First Name
Discriminator's Middle Initial
Discriminator's Last Name
Organization
Address Line 1
Discriminator's City
Discriminator's State
Alabama
Alaska
America Samoa
Arizona
Arkansas
California
Colorado
Connecticut
D.C.
D.C.
Delaware
Federated States of Micronesia
Florida
Foreign Correspondence
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Trust Territory
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Discriminator's Zip
Discriminator's Email
Discriminator's Confirm Email
Work Phone
Required
Please check this box if you want to proceed.
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. Check the box to confirm that you understand this statement.
Yes
Required
Please check this box if you want to proceed.
Affirmation
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