Elementor #9532

FIRST NAME*
First
LAST NAME*
EMAIL ADDRESS*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
PHONE NUMBER*
BEST TIME TO CALL*
Are you involved in a current LDF case?*
- YES
- NO
if yes, please explain:
Please provide a complete and detailed description of the events giving rise to your request for assistance, including:
1. What happened? 2. Dates, places, and the names of the people directly involved. 3. What explanation, if any, was given for what happened? 4. Why do you think this happened to you? 5. What steps, if any, have you taken (filed a complaint or appeal with the parties involved, any public agency or official, or any other organization)? 6. To whom did you complain and what is the status of the complaint? 7. What documentation do you have on the matter?
Please state clearly what you would like NAACP Legal Defense Fund to do for you.*
List any other agencies from whom you have requested assistance.*
AGREEMENT*
Please check this box to indicate that the information you have provided is true and correct; that you understand that, by accepting this complaint form, the NAACP Legal Defense Fund is not agreeing to represent you; and that you understand that the NAACP Legal Defense Fund is not responsible for ensuring that any statute of limitations requirement or other deadline is met in your case.
- YES, I UNDERSTAND
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