MANCHESTER NAACP, UNIT 2069, Est. 1964

Discriminated Against?

Branch Complaint Form
Know that the Manchester NAACP stands with you to advocate and pursue justice. In order for us to collaborate and accomplish this task, the first step begins with the complaint form. The form must be filled out with as much detail as possible. All information is kept confidential until given permission to share. The Branch does not guarantee action for incomplete forms.
 Date: *  
First Name: *
Last Name: *
Phone:
Mobile:
 Address: *  
City: *
Zip Code: * (5 digits)
State:
Phone:
Mobile Phone:
Email:
1) What happened? (Describe incident in detail)

2) Where did the incident occur?

3) Who is the individual/company complaint is against?

4) Witnesses to complaint?

5) Date complaint occurred?

6) What is the action desired?

**All questions pertained to the incident in this section MUST be answered before we move forward**

*

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