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.

The Office of Human Rights is fully accessible. Please inform this office if special accommodations are needed by calling (410) 313-6430, Fax (410) 313-6468, or placing a TTY call to (410) 313-6401.