CITY OF DULUTH HUMAN RIG HTS O FFI CE
DI SCR IM IN AT ION INTAK E QUESTIO NA IRE
Provide as much contact information as possible. If the Office cannot locate you, your case may be dismissed.
This information is only used to investigate your complaint and no for no other purposes.
There is no filing fee to draft a complaint.
You have one year from the date of the alleged discrimination to file a charge.
An attorney is not required to file a charge though some people do hire an attorney.
To speak with someone about your rights under the Duluth Human Rights Ordinance or for more information
about filing a charge of discrimination, feel free to call or email the Human Rights Office.
First Name ____________________________ Last Name me_____________________________
Phone Number ________________________ Email ___________________________________
Address ______________________________ City _____________State_______ Zip _________
You feel you were discriminated against based on: (check all that apply)
You can mail, fax, email, or hand deliver this form to the Human Rights office (see contact info below.)
Submitting this form does not mean you have filed a complaint. This form is part of an intake process. You
can also begin the intake process by calling, visiting, or emailing the Human Rights Office. This is the first
step to initiating a Discrimination Complaint and you will be contacted by the Human Rights Office to further
discuss and investigate alleged discriminatory act(s) and the investigatory process.
City Of Duluth Human Rights Office
City Hall, Room 407
411 West First Street
Duluth, MN 55802
Fax: (218) 730-5904
Information you provide is subject to the Minnesota Government Data Practices Act.
This law classifies certain information as available to the public upon request
Race Color Creed Religion
National Origin Sex Sexual Orientation Age
Marital Status Public Assistance Status Familial Status Disability