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Discrimination Complaint FormPrint this Page

City of Milwaukee Equal Rights Commission
City Hall, Room 606, 200 East Wells Street,
Milwaukee, WI 53202
Phone: (414) 286-5900
ERC@milwaukee.gov
milwaukee.gov/ERC


The City of Milwaukee Equal Rights Commission can only investigate discrimination complaints that took place within the City of Milwaukee. If the discrimination took place outside of the City of Milwaukee, please call our office at (414) 286-5900 for a referral to the correct entity.

 

Complainant Information

In Red is Required

First Name:

Last Name:

Middle Initial:

Street Address:

City:

State:  

Zip:

Main Phone Number:  

Phone Type:

Other Phone Number:

Phone Type:

Email Address:


Respondent Information

(The person or entity you believed discriminated against you. Name only ONE respondent per form.)

Name:

Email:

Main Phone Number:

Street Address:

City:

State:

Zip:


This Complaint is About Housing   Public Acommodations   Employment

Basis for Discrimination

I believe the Respondent discriminated or took action against me because of:

Can select multiple

COVID 19 Coronavirus Diagnosis or perceived relation to COVID 19
Age Homelessness Sex
 Disability Lawful Source of Income  Sexual Orientation
Color  Marital Status  Source of Income
 Domestic Partnership  National Origin/Ancestry  Victimhood of Domestic Violence
 Familial Status  Past/Present Military Membership
 Gender Identity Expression
 Genetic Identity  Race  
 HIV Status  Religion  

Discrimination Incident Information

Location of the incident:

Date of the incident:

Time of the incident:

Witness Name:

Witness Email:

Witness Phone:


Statement/Description of Discrimination

Write a brief, concise statement explaining in detail how you were discriminated against. Explain how the discrimination incident was related to the “Reason for Discrimination” box(es) you checked.


Desired Outcome

What would you like to have happen as a result of filing this complaint?

Do You Have Attorney Representation? Yes No

Attorney Name:

Email:

Phone:

Have You Filed a Complaint With Any Other Agency? Yes No

Agency Name:

Date Filed:


Signature

By signing my name in the space provided below I affirm that all information in this complaint is true and correct to the best of my knowledge and that the discrimination took place within the City of Milwaukee. 

By checking this box and typing my name below, I am electronically certifying my signature


Complainant Signature

Date
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