PROSPECTIVE CLIENT
cIVIL rIGHTS

TYPE:	DATE(S) OF DISCRIMINATION
BASES:	AGE	COLOR	DISABILITY	FAMILY	Earliest	Latest
GENETIC	MARITAL	NAT. ORIG.	RACE	Click or tap to enter a date.	Click or tap to enter a date.
RELIGION	RETAL.	SEX	OTHER	CONTINUING ACTION

PLAINTIFF:

NAME:
ADDRESS:
CITY:	STATE:	ZIP:
EMAIL:	PHONE:

DEFENDANT:

NAME:
ADDRESS:
CITY:	STATE:	ZIP:
EMAIL:	PHONE:
SIZE:

EVENTS:	Constructive Discharge	Demotion	Failure to Hire	Failure to Promote	Hostile Work Environment
Reasonable Accommodation	Suspension	Termination	Terms & Conditions	Unequal Pay

SHORT & PLAIN STATEMENT (256-Character Limit):

DATE:	4/19/2024