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Annual Internal Complaint Form

Untitled Document

If your agency is not included in this drop down list, please include it in the "Comments" field below.

Please identify the total number of internal complaints filed with your agency for this reporting period that involved discrimination or harassment on the basis of a protected class under the MN Human Rights Act.

Please identify the number of complaints for each basis (protected class) listed below. If a complaint was based on more than one basis (protected class), include each/all.

*Age
*Race
*Color
*Creed
*National origin
*Religion
*Sex
*Status with regard to public assistance
*Disability
*Sexual orientation
*Membership in local human rights commission
*Marital status
*Comments
*Name of person submitting this report
*Checking this signifies an electronic signature
*Phone

* mandatory field

If you have questions about completing this report, please contact Johnnie Burns

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