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Home   >    Departments   >   County Administration   >   Human Rights   >   Forms and Publications   >   Intake Information Form

 

Intake Information Form

The information requested on this questionnaire will help us to help you. There is no guarantee that the information submitted will constitute a basis for filing a formal complaint. If you need assistance in preparing this questionnaire, please call the Office of Human Rights at (410) 313-6430.

Complainant:
Respondent:
(Click the arrow to the right to see the selections. Check all that apply)