Legal Redress

If you want the NAACP to investigate a complaint of discrimination, please fill out the form below. You can then speak to a member of the Executive Committee of the Loudoun County Branch, and a determination will be made as to whether the NAACP can assist you in pursuing your complaint. For complaints specific to Loudoun County Public Schools, please use this form instead.

You may also download and print a PDF version of this form. Send completed form to:

Loudoun County Branch NAACP
Attn: Legal Redress Committee
P. O. Box 2439
Leesburg, VA 20177

1

All fields are required. Incomplete applications cannot be investigated.

2

Describe specifically what happened that caused you to file your complaint.

Please select your race from the following (see definitions at the bottom of this page):








3

Please describe the circumstances in which you were discriminated against, or were the victim of an unlawful act:

By whom were you discriminated against? - Please include name, race and gender of each individual:

Where did the discrimination take place? Cite location/address for each incident:

Were there witnesses to what took place? Please include name and as much contact information as possible (address, email, phone) for each individual:

4

What was the effect or impact of the discriminating behavior on you?

To date, what actions have you taken so far?

Have you filed a complaint with or notified any other organization or individual regarding this matter?



Name of person(s) or organization(s) with whom you have filed your complaint:

What actions, if any, were taken in response to your complaint or notice of concern?

Who took these actions?

When were these actions taken?

What would you like the NAACP to do for you regarding this matter?

5

Release of Liability

I affirm that the statements that I have made above are accurate and true to the best of my knowledge and belief. I hereby request the assistance of the Loudoun County, Virginia Branch of the NAACP in seeking a remedy to the situation described above. I hereby authorize the officers of the Loudoun County NAACP to have access to any information and documents, hard copy or electronic, that are relevant to my claim of discrimination described above.

I understand that once a referral to a volunteer, community agency or private attorney has been made, the Loudoun County NAACP will not be responsible for handling this matter. By checking the box below, I agree to hold the Loudoun NAACP harmless for any and all damages arising as a result of my case being mishandled or any negligence in any way.


Non-Retaliation Requirements: Section 704(a) of the Civil Rights Act of 1964, (as amended), Section 4 (d) of the Age Discrimination in Employment Act of 1967, (as amended), and various other civil rights laws make it an unlawful practice for an employer; employment agency; or labor organization to discriminate against employees, applicants for employment, member or applicant for membership, because the employee, member or applicant has opposed an unlawful employment practice, made a charge, testified, assisted, or participated in any manner in an investigation, proceeding or hearing.

Completion of this form does not constitute filing an official complaint with a legal authority. At this time the Loudoun County NAACP is only seeking information to assist you concerning this complaint.

Verify

Script by Dagon Design

* Definitions:

  • African American/Black – People having origins in any of the Black racial groups of Africa. Not of Hispanic Origin.
  • Native American, American Indian or Alaskan Native – Persons who maintain cultural identification through tribal affiliation or community recognition.
  • Hispanic – Persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless  of race.
  • Asian or Pacific Islander – Persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian  Subcontinent, or the Pacific Islands. This Area includes for example, China, India, Japan, Korea, the Philippine Islands, or Samoa.
  • White – Persons having origins in any of the original peoples of Europe, North Africa or the Middle East. Not of Hispanic origin.