Submit a Discrimination Complaint

Important Notes about this form:

• The Office of Equity will maintain the confidentiality of your name and discrimination complaint to the best of their ability; however, the City cannot guarantee the information will remain confidential. The Texas Public Information Act allows the public release of any information held by the City of San Antonio. Your name and discrimination complaint may be made public if the City of San Antonio receives a request for the information.
• The complaint should be in writing and contain information about the alleged discrimination such as name, address, phone number of complainant and location, date, and description of the problem. Alternative means of filing complaints will be made available upon request.
• The red asterisk (*) means that the field is required in order to submit the form.
• Any entries made may be lost if there is no activity (clicking/typing) within 25 minutes.

Complainant's Information - Section 1 of 4

Complainant's Name*:

Phone number*:

Street address*:

City*:

State*: -- Select State -- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Wisconsin Wyoming

Zip Code*:

Email*:    Note: A copy of the information submitted in this form will be sent to this email address.

Additional Contact Information (Optional)

Name of person who knows where and how to contact you:

Phone number

Street address:

Complaint Against - Section 2 of 4

Name of person or business*:

Title, if known:

Contact person, if other than above:

Phone number:

Street address where incident took place*: Note: The NDO applies to conduct occurring within the city limits of the City of San Antonio.

Complaint Details - Section 3 of 4

Basis for complaint, check all that apply (you must select at least one)*: Age Color Disability Family Status Gender Identity National Origin Race Religion Sex Sexual Orientation Veteran Status

Date of incident:

Please explain, as clearly as possible, what occurred, who was involved, why you believe it occurred and how you were discriminated against. Be sure to include how other persons were treated differently than you.

Other Reports or Discussions about this Complaint - Section 4 of 4: Other Reports or Discussions about this Complaint

Have you filed, or intend to file a complaint with another agency? If so please identify agency: -- Select Agency -- Federal Transit Administration Office of Federal Contract Compliance Programs Texas Department of Transportation U.S. Department of Housing and Urban Development U.S. Department of Justice U.S. Department of Transportation Highway Administration U.S. Equal Employment Opportunity Commission Other

If other, please provide the name of the agency:

Have you discussed the complaint with any city representative? Yes No

Please provide the following information: Name of City representative: Position of City representative: Date of discussion:

Have you filed a Police Report? Yes No

Case #:

Submit Complaint & Confirmation

I swear or affirm that all of the information contained in the complaint is true to the best of my knowledge and information.*