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2. Submitting this form will send its contents to the Lexington Human Rights Committee. 

   Please note that correspondence with the Lexington Human Rights Committee is public.

4. Complainant

   This is you.

6. Name*
7. Email Address
9. Address*
11. City*
12. State*
13. Zip Code*
15. Phone Number
16. Alternate Phone Number
18. Respondent

    This is the person you think violated your rights.

20. Name of Individual
21. Name of Business (if applicable)
23. Address
25. City
26. State
27. Zip Code
29. Phone Number
30. Email
32. Rights Violation
34. In what area do you believe your rights were violated? (Check all that apply.)

    1. Credit/Lending
    2. Education
    3. Employment
    4. Housing
    5. Public Accommodation (see the following for more information)
    6. Public Area
    7. Recreation
    8. Services
    9. Other
35. Other: Please describe

37. What are Public Accommodations? (Opens in new tab)

39. Why do you believe your rights were violated? (Check all that apply)

    1. Race
    2. Ethnicity
    3. Color
    4. Religious views
    5. National origin
    6. Citizenship
    7. Age
    8. Ancestry
    9. Family/marital status
    10. Disability
    11. Military status
    12. Source of income
    13. Sex
    14. Sexual orientation
    15. Gender identity or expression
    16. Other
40. Other: Please describe
42. Please summarize how you feel your human rights were violated.*
44. Date of most recent incident
    Date of most recent incident
46. Optional: What remedy are you seeking? (How do you want us to help?)
48. If another agency is investigating this incident, which one(s)? (Check all that apply.)

    1. United States Equal Employment Opportunity Commission (EEOC)
    2. Massachusetts Commission Against Discrimination (MCAD)
    3. Massachusetts Attorney General
    4. Massachusetts Department of Education
    5. Other
49. Other: Please describe
Leave This Blank:


51. 1. Receive an email copy of this form.
52. Email address

    This field is not part of the form submission.

53. Submit

* indicates a required field