Complaint Questionaire (Haga clic aquí para español)

If you feel that you have been discriminated against, fill the form provided below and one of our Enforcement Officers will contact you.

You may also download a printable version by clicking here.

Please indicate the area of discrimination (Employment, Housing, Public Accommodation, Financial Transaction, Other)

Please indicate the type of discrimination (Race or Color, Religion, National Origin, Sex, Disability, Age (40 and over; employment only), Familial Status (housing only), Retaliation, Smoking)

Who discriminated against you? Give name and address of the employer, labor organization, employment agency, licensing agency, apprenticeship committee, public accommodation, real estate broker, lender, or apartment manager.

Identify the actual date or the most recent date on which this discrimination occurred?

Explain what unfair thing was done to you.

You may also submit your complaint via postal mail or by telephone:

Versailles-Midway-Woodford County Human Rights Commission
P.O. Box 101
Versailles, KY 40383
859-873-2159

First Name
 
Last Name
 
Company Name / Govt. Agency
 
Street Address 1
 
Street Address 2
 
City
 
State
 
ZIP
 
County
 
Phone
 
Email
 
Subject
 
Message