Discrimination Complaint Form
City of Milwaukee Equal Rights Commission
City Hall, Room 603, 200 East Wells Street,
Milwaukee, WI 53202
Phone: (414) 286-5900
[email protected]
milwaukee.gov/ERC
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City of Milwaukee Equal Rights Commission – Discrimination Complaint Guidance
The Equal Rights Commission can only investigate discrimination complaints that occurred within the City of Milwaukee. If the incident happened outside Milwaukee, please call (414) 286-5900 for a referral.
For language assistance or alternative submission methods, call (414) 286-5900.
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Language & Accessibility Help
If you need help in another language or format (such as large print, screen reader access), call (414) 286-5900.
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:
Filing on Behalf of Another Person
If you are submitting this form for someone else—a child, adult, or someone needing assistance—complete the following:
Are you filing on behalf of another person? Yes No
If Yes, please sign your name at the end of the form.
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 Accommodations Employment Other
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 | Other | ||||
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
If submitting for another person, indicate your relationship
(Parent, Guardian, Authorized Agent, Other)
Complainant Signature |
Date |
Representative Name & Relation |
Date |
Submission Notice
Once submitted, an ERC representative will contact you within five business days using the information you provided.
Thank you for taking the time to file your complaint.