Complaint Form

Please fill out the required fields to file an official compliant with the Springfield, Ohio NAACP.

If you have questions about completing this form, please contact our office at 937.521.2650 office during our regular office hours: Tuesdays & Thursdays 12:30 - 4:00 PM or send a fax to 937.521.2651.

Today's Date * required

Are you a NAACP member? *

Yes

No

Full Name

Home Address

City

Region/State/Province

Postal / Zip code

Phone

Email

Provide the full name of the entity you have a compaint against. (Respondent)

Breif expaination of complaint

What type of discrimination case are you pursuing? * Required

Criminal Justice

Police Misconduct

Housing

Education

Employment

Religion

Healthcare

Other

Do you have a witness to support your claim? If yes, please bring copies with you. *

Yes

No

Have you tied to resolve the issue through any formal or informal grievance process? If so, with whom?

Have you contact any other organization about this issue? If so, please list them.

Thanks for submitting!

Serving Clark, Greene, and Champaign Counties

20 S. Limestone St., Suite 20,Springfield OH 45502

937.521.2650 office | 937.521.2651 fax

Office Hours: Tuesdays & Thursdays 12:00 Noon - 2:00 PM

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