[Montgomery County, MD] Office of Human Rights - Claim and Inquiry Intake Form

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Montgomery County Government Office of Human Rights - Claim and Inquiry Intake Form

NOTE: This form is for intake/inquiry only; it is not a filed complaint. An investigator or staff member will contact you if your inquiry is accepted for investigation by this agency.

Tracking Number

You will be provided with a Tracking Number upon submission.

Do you have an appointment with an Investigator?

Complainant Phone Number

Complainant Email

Complainant Date of Birth

Respondent (Person/entity that committed the alleged act or incident)

Respondent Phone Number

Number of Employees

When did the incident/discrimination happen?

Have you filed a complaint with another agency or in court?

Yes

In the following box please describe the facts of the claim/alleged violation