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Please download or printout the complaint form if you feel that you have been discriminated against or need help from the NAACP to resolve a problem. After opening and filling out the form, please mail it to the Legal Redress Committee at the address listed on the form.

Click Here to download complaint form http://www.chesterfieldnaacp.com/LinkClick.aspx?fileticket=80UrEMS6fI8%3d&tabid=136&mid=510

NOTICE: Please send email to jbsharpe8@verizon.net to request & receive a copy of the newly revised Legal redress complaint form by email .

Chesterfield County NAACP

Legal Redress Council

Branch 7120

P. O. Box 246

Chesterfield, Virginia 23832

Complaint of Discrimination

Please print or type

Name: _________________________________________________________________________________________

Address:_______________________________________________________________________________________

City: ______________________________ State: ______________ Zip Code: _______________________

Telephone:_________________(H) __________________(c) Email: _________________________________

Please check the box that pertains to your discrimination:

Education Employment Other

If you checked other, please explain: _____________________________________________________

________________________________________________________________________________________________

Date of incident _______________________________ Approximate Time: ______________________

Have you filed a complaint with an agency? Yes No If yes, please state the

agency:_______________________________________________________________________________________

Have you retained an attorney? Yes No If yes, please provide the following:

Attorney's Name: ___________________________________________________________________________

Address:______________________________________________________________________________________

Telephone Number:__________________________ Email: ______________________________________

Note: The filing of this complaint does not constitute filing an official complaint with a legal authority nor does it obligate the NAACP to pursue your case in the appropriate court or administrative tribunal. The Legal Redress Council will review your case and upon review will make a decision as to whether or not your case warrants our assistance.

Chesterfield County NAACP

Legal Redress Council

Branch 7120

P. O. Box 246

Chesterfield, Virginia 23832

To better assist the Legal Redress Council in gaining an understanding of the nature of your complaint, please state against whom he complaint is being made, any steps that have been taken to resolve the complaint and what your are seeking from the Chesterfield County Branch NAACP. Please feel free to attach copies of any supporting documentation.

_________________________________________________________________________________________________________

I affirm by signing and dating this form that the information provided is true.

______________________________________________ ______________________________________ Signature of person filing complaint Date

Complaint, continued

Name:______________________________________

_________________________________________________________________________________________________________