Human Rights Commission Complaint / Incident Form

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Spokane Human Rights Commission
Complaint / Incident Form

The mission of the Spokane Human Rights Commission:
To
promote and secure mutual understanding and respect among all people regardless of race, color, sex, ancestry, gender, religion, affectional/sexual orientation, age, disability, familial/marital status or economic status
To
help groups and individuals work out differences in cases of alleged discrimination
To
work with organizations, groups and leaders encouraging them to be advocates for eliminating discrimination and improving human relations
To
conduct programs in the community which increase respect for all people.

Please Note: Filing a complaint with the SHRC will not satisfy filing requirements for any State or Federal actions for violation of civil rights or unlawful discrimination.

Complaint:

Generally, when one files a complaint with the SHRC, it is a grievance of discrimination based on categories stated in the SHRC MISSION: race, color, sex, ancestry, gender, religion, affectional/sexual orientation, age, disability, familial/marital status or economic status or unfair treatment usually requiring intervention or advocacy by the SHRC.

Incident:

An incident is generally defined as a consequence or event that is motivated by bias based on categories stated in the SHRC MISSION: race, color, sex, ancestry, gender, religion, affectional/sexual orientation, age, disability, familial/marital status or economic status. An incident can be considered something as simple as mischief or as serious as a hate crime. Incidents do not normally require SHRC intervention or advocacy.

Unsure? If your report does not fall within the parameters above, it may be forwarded to the most appropriate agency.

1. Your Name or Name of Complainant:

First: Last:

2. Address of Complainant:

Street:

City: State: Zip Code:

3. Phone number or way to contact complainant for follow-up

(with area code) :

Email: (if available)

4. Complainant’s Demographics: (Necessary for trend analysis)

Race / Color: Age:

Disability:

If you only want to report a particular incident to the SHRC, please proceed to Number 10

5. On what date(s) did the discrimination take place:

6. In your opinion, why were you (or the complainant) discriminated against? Please click all that apply:

Race / Color	Age	Religious Affiliation
Sex / Gender	Sexual Orientation	Disability
Familial/Marital Status	Economic Status	Ancestry
Other
If Other, please describe: 7. Has a complaint been filed with any other authority? Yes No If Yes, please describe: 8. What has been done to resolve the complaint at the lowest level? 9. COMPLAINTS ONLY: Please explain, concisely, your complaint (Note: Include names of persons and dates / times of occurrences.): (Definition of a Complaint) 10. INCIDENTS ONLY: Please describe the incident you witnessed or were subjected to ( Note: Include names of persons and dates / times of occurrences.): (Definition of an Incident) 11. What is your desired outcome of this complaint / report? 12. Do you want your complaint / report kept confidential? Yes No Please Note: If you chose "Yes", the response of the Commission will be limited.

13. Do you wish to be advised of progress? Yes No

14. How would you like us to reach you?

Phone Address Email