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Public Accommodation Discrimination Complaint Form

Public Accommodation Discrimination Complaint Form

Instructions for Completing: Public Accommodation Form

The Nevada Equal Rights Commission is charged with the enforcement of employment, housing and public accommodations, state and federal discrimination laws, under NRS 233 and 613 inclusive; Title VII of the Civil Rights Act of 1964, as amended; Age Discrimination in Employment Act of 1967, as amended; and Equal Employment Opportunity Commission procedural regulations; housing NRS 118 and Public Accommodations NRS 651.

NOTE: Your complaint must be filed within 300 days from the last alleged discriminatory act.

Section A

Section B

Physical Address

Section C

Give the name of someone who can help us reach you.

Physical Address

Section D

Section E

This is a complaint of discrimination based upon:
(Mark only the reasons which you believe caused the discriminatory act(s) that you are claiming.)

Section F

List the name(s) of the individual(s) that you are claiming participated in the alleged discrimination:

Section G

List any witnesses to the alleged discrimination:

Section H

750 Character(s) Remaining

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