STEP #1: Read the below Authorization.
Completion and submission of this form is my authorization to the King William County Virginia Branch NAACP and/or the Virginia State Conference NAACP (hereinafter referred to as “NAACP”) to investigate my compliant and/or mediate my compliant with the Respondent in an effort to explore the possibility of a settlement regarding the nature of my complaint.
I understand that the NAACP is not a law firm and that it cannot provide me legal advice or provide legal representation; therefore, I am not precluded from seeking litigation against the Respondent should the individuals fail to reach an agreement.
Furthermore, I understand I have the right to revoke this authorization at any time by submitting a written request, unless a proposed settlement has already been accepted.
Authorization, unless revoked in writing, shall expire within one-year from the date of authorization.
Finally, I release and hold harmless the NAACP, its officers, directors, employees, agents and volunteers from personal actions, causes of actions, suits, debts, dues, sums of money, accounts, reckonings, bonds, bills, specialties, covenants, contracts, controversies, agreements, promises, variances, trespasses, damages, judgments, executions or claims and demand whosoever in law in equity which I have ever had, may have in the future or that any of my personal representatives, successors, heirs or assigns hereafter can, shall or may have against the NAACP by reason of the NAACP’s handling of my complaint.
By providing your email address and cell phone number on this form, you authorize the NAACP to contact you via email and text messages.
STEP #2: Read the below Release.
Completion and submission of this form is my affirmation that the statements that I have made above are accurate and true to the best of my knowledge and belief. I hereby request the assistance of the NAACP in seeking a remedy to the situation described above. I hereby authorize the officers of the NAACP to have access to information and documents, which are relevant to my claim of discrimination described above.
I understand that once a referral has been made to a volunteer, community agency or private attorney, the NAACP WILL NOT BE RESPONSIBLE for handling this matter. I further understand that by signing this document, I am agreeing to HOLD the NAACP harmless for any and all damages arising as a result of my case being mishandled, negligently handled or improperly handled in any way.
STEP #3: Read the below Requirements.
Section 704 (a) of the Civil Rights Act of 1964, (as amended), Section 4 (d) of the Age Discrimination in Employment Act of 1967, (as amended), and various other civil rights laws make it an unlawful employment practice for an employer; employment agency; or labor organization: to discriminate against employees, applicants for employment, member or applicant for membership, because the employee, member or applicant has opposed an unlawful employment practice, made a charge, testified, assisted, or participated in any manner in an investigation, proceeding or hearing.
STEP #4: Read the below Notice.
Please be advised that filing a discrimination complaint with the NAACP does not mean that the NAACP will be representing you in any legal matter. If you believe you have a discrimination claim, you must file a claim with the appropriate State or Federal agency in a timely manner. Failure to do so may prevent you from pursing a claim in a court of law.
STEP #5: Read the below Form Purpose.
The function of the Legal Redress Committee is to:
Acknowledge receipt of all complaints in a timely fashion;
Investigate all cases that have been identified as discriminatory;
Provide support to complainants which may include, but is not limited to:
Providing information that complainants can use to address or remedy their situation
Facilitating/participating in meetings
Writing emails or letters
Referring for legal services
Monitor all litigation in which the branch is interested; and
Keep the conference informed on the progress of every case.
The Legal Redress Committee (LRC) shall not give legal advice or representation.
Please note, if your incident did not take place in King William County, your information will be forwarded to the appropriate NAACP branch
Step #6: Enter the details of your complaint.
Please enter the requested information in the fields below.
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Instructions:
Anyone may file a complaint by entering the information into the fields to the left of this page and selecting the yellow submit button. Complaints filed using this form will also be forwarded to the Virginia NAACP for investigation and processing. Alternatively, you may download the form by clicking this link and sending completed forms to legalredress@naacpkwva.org or mailing it to Virginia NAACP, PO Box 27212, Richmond, Virginia 23261.
King William Branch NAACP
694 Sharon Road, King William, Virginia 23086, United States