Human Relations Committee Online Inquiry

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NOTE: THE ONLINE INQUIRY FORM IS NOT A COMPLAINT.
COMPLAINTS must be filed in writing, signed, and properly verified by the individual alleging discrimination.
Any person claiming to be aggrieved by a discriminatory practice or act occurring in West Lafayette may file a signed, written, and properly verified Complaint in the office of the Mayor.  A copy of the West Lafayette Human Relations Commission’s (“WL HRC”) procedures for resolving complaints of discrimination, along with Complaint forms are on file in the Mayor’s Office and available through the WL HRC's webpage. 
In an effort to make the process of filing Complaints more accessible, the WL HRC has developed an Online Inquiry Form.  However, the Online Inquiry Form below is not a Complaint.  The Online Inquiry form merely provides intake staff with background information.  A written complaint must be signed, properly verified and filed in the Mayor’s Office within ninety (90) days from the date of the occurrence of the discriminatory act.   
If you choose to submit an Online Inquiry Form, an intake person will deliver your information to the WL HRC’s Chairperson.  If after a preliminary review, it appears the WL HRC has jurisdiction over the alleged discrimination, you will be contacted in order to arrange a time and place for you to sign a verified Complaint based on the information submitted in the Online Inquiry Form.  Please note:  
1. That you will not have a complaint on file until a written Complaint Form is signed, verified, and filed in the Mayor’s Office; and
2. The Online Inquiry Form in no way modifies the deadline that a written Complaint must be filed within ninety (90) days.

* Denotes a required field
 

Complainant Information

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ZIP*
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Second portion of ZIP Code is optional.
Phone*
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Respondent Information

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ZIP*
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Second portion of ZIP Code is optional.
Phone*
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State the specific facts constituting the discrimination

Date of Alleged Discriminatory Act*
 Date of Alleged Discriminatory Act
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The Commission shall not consider any complaint concerning any matters for which the Complainant has filed, or intends to file, complaints with the EEOC or Indiana Civil Rights Commission.

Have you filed a complaint with any other business, organization, court or governmental organization?*
If yes, please provide the name of the group, the date the complaint was filed and the status of the complaint.
 
Date of Filing 
 Date of Filing