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2. City of Brighton
4. Anti-Discrimination Complaint Form

   If you feel that you have been discriminated against, please complete the below Anti-Discrimination Form completely. We ask that you return the completed form to the City of Brighton’s Anti-Discrimination Coordinator via email, mail, or in person within 30 days of the alleged incident. 

   
   

   Complaints will be processed as quickly as possible. You should receive a response within 72 working hours after your request has been submitted. 

   If you require assistance completing this form or have questions, please contact the Anti-Discrimination Coordinator at ADCoordinator@brightonco.gov.

6. First Name*
7. Last Name*
9. Address1*
11. Address2
13. City*
14. State*
15. Zip*
17. Phone Number*
19. E-mail
21. How would you like us to contact you?*

    1. E-mail
    2. Mail
    3. Phone
23. Who do you believe discriminated against you or harassed you?
25. Name of person
26. Date
    Date
28. Location/Department/Office
30. Please check the box for the type of discrimination or basis of discrimination or harassment:

    1. Race
    2. Color
    3. National Origin
    4. Ancestry
    5. Sex
    6. Gender
    7. Gender identity
    8. Age

    1. Pregnancy status
    2. Religion
    3. Creed
    4. Disability
    5. Sexual orientation
    6. Genetic information
    7. Marital or civil union status
    8. Veteran status
32. Complaint Information*

    Please be specific and provide as much information as possible. 

Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field