Discrimination Form

Discrimination Form

Form Used For Feedback and evaluations on discrimination issues by clients.

Categories:
Feedback And Evaluation
Tags: Discrimination,Fighting For Our Rights,Brandie Rose DeVore,LGBTQ Rights,Legal forms,Researching data,
Shared by: brandieRoseDeVore

Discriminated against?

If you've been discriminated against, Fighting For Our Rights wants to hear from you. Fill out the form below to let us know how you've been affected.We will treat the information that you provide through this formas confidential.
Name *

First Name Last Name
Email *
example@example.com
Phone Number *

- Area Code Phone Number

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

How do you prefer we get in touch with you? *

1 Phone 2 Email
Please describe how you may be affected by discrimination:
What pronouns would you prefer we use for you?

She/ Her/Hers They/Them/Theirs Other His/Him/He
Enter the message as it's shown *
Should be Empty:

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