Form Center

Your Information

Please check off the appropriate boxes below if you believe they played a role in your complaint:
1. Race
2. Color
3. Disability
4. Source of Income
5. National Origin
6. Marital Status
7. Gender
1. Religion
2. Age
3. Family Status
4. Retaliation
5. Sex
6. Sexual Orientation
7. Military Status
Discrimination Types
1. Housing - If you feel you have been discriminated against in your search for housing, while living in your current housing, or in any housing related transaction.
2. Public Accommodation - If you believe you have been discriminated against by a business, or a place open to the public in Amherst.
3. Employment - If you believe you have been discriminated against in your place of employment, by a labor organization, or by an employment agency in Amherst.
4. Education - If you believe you have been discriminated against by an educational facility in Amherst.
5. Other - Anything that does not fit in to one of the above types. Please fill out details below.
Why do you believe you were discriminated against?*
Who do you believe discriminated against you? Please provide a name if possible. *
What happened?*
When did the discrimination happen (date)?*
When did the discrimination happen (date)?
Address where the discrimination happened? *
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