Kentucky Commission on Human Rights

Complainant Inquiry Form

Complainant Information

* First Name

Middle Initial

* Last Name

Preferred Pronouns

* Address Line 1

Address Line 2

* City

* County

* State

Email Address

Zip Code

* Phone Number

EMERGENCY CONTACT INFORMATION

In order to serve you better, please provide emergency contact information below.

* Emergency Contact Name

* Emergency Contact Phone Number

* Emergency Contact Relationship

Respondent Information

* Who is the complaint against? (Please list the name of the person and/or the business/organization/housing provider)

* Address Line 1

Address Line 2

* City

* County

* State

* Zip Code

Email Address

* Phone Number

Complaint Summary

* Type of Complaint

Public Accommodation (within 180 days)

Employment (within 180 days)

Housing (within 1 year)

Financial Transactions