Civil Rights Intake Questionnaire

Individuals who believe they are victims of discrimination should submit a Civil Rights Intake Questionnaire to the Arizona Attorney General's Office.

After you complete this questionnaire you will be contacted within approximately 24 hours to schedule an intake interview with this office. If you prefer to submit by mail, please download and print this form for submission.

 


Your Information

Contact Info
Alternate Contact Info

Party or Firm You Are Complaining Against

Business Name

Complaint Information

Please indicate all of the following categories that apply to your complaint against the person or business listed above:

Employment
Housing
Public Accommodation (Restaurant, Store, Museum, Theatre)
Voting

 


Thank you for taking the time to complete this questionnaire.

You will be contacted within approximately 24 hours to
schedule an intake interview with this office.