Community Relations Commission

2. First Name
3. Last Name
5. Address1
7. Address2
9. City
10. State
11. Zip
13. Email
15. Phone Number
17. Information About the Discrimination Activity

    Details might include Date/Time, Name of person(s) involved, Location of Activity, Etc.  "Discrimination" means any difference in treatment based on race, creed, color, sex, sexual orientation, gender identity or expression, national origin or ancestry, marital or familial status, religious belief, age, or disability.

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19. 1. Receive an email copy of this form.
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