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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)

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.