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Discrimination Complaint Form

  1. Complete this form to file a complaint of discrimination at any place of public accommodation located in Orange County, or to file a complaint of discrimination with respect to an Orange County Government program or activity. There is no cost to file a complaint.

    Your discrimination complaint will be reviewed by a specialist to determine if it alleges acts that might violate Article VI of the Orange County Civil Rights Ordinance; 40 C.F.R. Part 5 and 7; Title VI of the Civil Rights Act of 1964, as amended; section 504 of the Rehabiliation Act of 1973, as amended; the Age Discrimination Act of 1975, as amended. The specialist will contact you for any additional information needed to complete this review. If your complaint involves a possible violation of one of the above laws, the specialist will assist you in filing an official complaint.

  2. Enter Your Personal Information

  3. Who else can we call if we cannot reach you?

    Contact Number 1

  4. Contact Number 2

  5. Enter Complaint Information

  6. Provide a specific and detailed description of the decision(s) or actions(s) including the date (or date range) which is alleged to have constituted unlawful discrimination in violation of Article VI of the Orange County Civil Rights Ordinance; 40 C.F.R. Part 5 and 7; Title VI of the Civil Rights Act of 1964, as amended; section 504 of the Rehabiliation Act of 1973, as amended; the Age Discrimination Act of 1975, as amended. Describe the harm alleged to have occurred, or which will occur, because of alleged discrimination. (4000 character limit)

  7. -Age (over 40)
    -Color
    -Disability
    -Familial status (families with children under 18)
    -National origin
    -Religion
    -Race
    -Sex
    -Veteran status

    Briefly explain why you think your rights were denied because of any the factors listed above. (4000 character limit)

  8. Who do you believe discriminated against you?

    Identify the parties alleged to be subjected to, or potentially impacted by the alleged discrimination.

  9. Where did the alleged act of discrimination occur?

    Provide the address.

  10. Is the alleged discrimination continuous/on-going?

  11. Leave This Blank:

  12. This field is not part of the form submission.