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Complaint of Discrimination

  1. Tell Us About Your Complaint

  2. (If the discrimination occurred on more than one occasion, then provide the date of the most recent occurrence.)

  3. Classification of the party against whom you are filing your complaint*

  4. The alleged discrimination happened because of one or more of the following Frederick County protected categories*

    Check all that apply

  5. Is the discrimination still occurring?*

  6. If needed

  7. Is the person filling out this complaint the same person against whom the alleged discrimination occurred?*

  8. INFORMATION CONCERNING THE PERSON AGAINST WHOM THE ALLEGED DISCRIMINATION OCCURRED

  9. Primary

  10. Secondary

  11. Leave This Blank:

  12. This field is not part of the form submission.