In order to complete this form, you will need:

• Your name, address, and phone number,
• Contact information of an individual who knows how to reach you,
• The name and contact information of the person or business that treated you unfairly, and
• A description of the harm you experienced.

You may need different information based on the type of claim you are bringing. If you are claiming discrimination or sexual harassment at work, you can use our Easy Form program.

If your claim involves sexual harassment, you will need:

• The name and job title of the harasser,
• Contact information for the harasser, and
• A description of the harassment.

If your claim involves a physical or mental disability, you will need:

• Information about your disability diagnosis, and
• A description of how the person or business was aware of your disability.

If your claim involves retaliation, you will need:

• The name and job title of the retaliator,
• Contact information for the retaliator, and
• A description of how you opposed unlawful discrimination.

If your claim involves a denial of financial credit, you will need:

• Your understanding of the qualifications needed to get credit, and
• A description of how you qualify.