|What did the respondent do? List each action that you believe was discriminatory. For example: I was not served, was harassed, could not fit my wheel chair, etc. Be specific regarding who, what, when and where. Then state why you believe that the treatment you received was because of the basis that you checked above.|
Add all pertinent information. If you have relevant documents that are saved as files on your computer, please attach(upload) them at the end of this form. Please mail in any other documents that are not able to be uploaded and reference those documents in the following entry field.