Submit a Tip

Inside CCHR Restorative Justice Contact Us

Report Discrimination

Please complete this form to make a report of discrimination. You can make this report whether or not you wish to be involved in an official complaint.

* Indicates required fields

Your Name:

Your Address:

Your E-mail Address:

Your Phone Number:

Choose category of discrimination: *

Name of the person(s) and/or business(es) who discriminated against you or someone else: *

Address or General Location of the person(s) and/or business(es): *

Phone number of the person(s) and/or business(es):

Date of most recent incident:

Have you filed a complaint with us before? *

Yes No

Please explain the issue or problem: *

Upload attachment 1: Choose a file…no file selected

Upload attachment 2: Choose a file…no file selected

Upload attachment 3: Choose a file…no file selected

How did you hear about the Commission?