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Submit a Discrimination Inquiry

This form will be submitted to the Office of Civil Rights and the City of Albuquerque ADA Coordinator. These offices will work together to review your inquiry. If your situation does not qualify for investigation by us, we will refer you to another agency for help

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Enter the first name of the person who referred you.
Enter the last name of the person who referred you.
Select the service you were seeking when you feel you were discriminated against.
Select the ways in which you were discriminated against.
Explain what happened that made you feel that you had been discriminated against.
The staff of the Office of Civil Rights and/or the ADA Coordinator strives to maintain the confidentiality of the information obtained during the course of an investigation and in most cases, it will only be divulged on a need-to-know basis. However, some of the records obtained or created during the investigation may be subject to disclosure under the Albuquerque Public Records statute. Check the box to confirm that you understand this statement.
I affirm that I have read the proceeding information and charge(s) and attest that it is true to the best of my knowledge, information, and belief. I have read and understand the confidentiality statement. I hereby give the Office of Civil Rights and/or the ADA Coordinator permission to thoroughly investigate my inquiry. I understand the information gathered will be kept confidential to the extent possible.
Complainant Information
Enter your chosen prefix (Mr., Ms., Mrs., etc.).
Enter your first name.
Enter your middle initial if applicable.
Enter your last name.
Enter the street and number of your home address. (Ex. 400 Marquette Ave. NE)
Enter the city for your home address.
Enter the zip code for your home address.
Use the format xxx-xxx-xxxx.
If you have already sent filed this complaint with another agency select "Yes".
I Believe I Was Discriminated Against By

Enter information about the individual or organization you believe discriminated against you.

Enter the chosen prefix of the person you believe discriminated against you.
Enter the first name of the person you believe discriminated against you.
If applicable enter the middle initial of the person you believe discriminated against you.
Enter the last name of the person you believe discriminated against you.
Enter the name of the organization you believe discriminate against you.
Enter the street address of the person you believe discriminated against you.
Enter the city for the address of the person you believe discriminated against you.
Enter the state for the address of the person you believe discriminated against you.
Enter the zip code for the address of the person you believe discriminated against you.
Enter the email address of the person you believe discriminated against you.
Enter the work phone number of the person you believe discriminated against you. Use format xxx-xxx-xxxx.
Select the option that best describes the person you think discriminated against you.