Discrimination Complaint Form

File a discrimination complaint/grievance with Cattaraugus County using the form below.

Before filing a discrimination complaint with Cattaraugus County about a local government, organization or institution, please read the following documents:

Note: If you rather fill out the form using a pen then please download the Discrimination Complaint Form, print it and follow the directions.

Complainant

Complainant's First Name

Complainant's Last Name

Complainant's City

Complainant's Zip Code

Person Discriminated Against

(if other than the complainant)

Government or Organization or Institution which you believe has discriminated:

Describe the acts of discrimination providing the name( s) where possible of the individuals who discriminated

Have efforts been made to resolve this complaint through the internal grievance procedure of the government, organization, or institution?

If yes: What is the status of the grievance?

Has the complaint been filed with another bureau of the Department of Justice or any other Federal, State, or local civil rights agency or court?

File with another Agency or Court

Please enter your *First Name, *Middle Name and *Last Name to confirm that you've filled out this form.

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