300 W Ash, Salina, KS, 67401, US
COMPLAINT INTAKE FORM
SALINA HUMAN RELATIONS COMMISSION
SALINA COMMUNITY RELATIONS DIVISION
P.O. Box 736 - 300 West Ash - Salina, KS 67401
Office: 785-309-5745 - FAX: 785-309-5745
Please answer the following questions, telling us briefly why you feel you have been discriminated against. Answer all questions as completely as possible. If you have already filed with a STATE or FEDERAL AGENCY, or if your complaint is about something that happened over 1 year ago, STOP and call our office. Upon completing this form, submit the electronic form and we will call to set up an appointment to talk with you concerning your complaint intake information.
***Please be advised that housing complaints are dually filed with the U.S. Department of Housing and Urban Development***
If you have more than one complaint, please fill out a separate form for each complaint.
Date of Birth
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Please provide the name of a person at a different address whom we can contact when unable to reach you:
Check any / all that apply:
"I believe I was discriminated against because of my..." (Check all applicable)
Upload any additional information regarding Incident(s) you feel are discriminatory
List names, addresses and telephone numbers of witnesses, and give description of the information they can provide that would support your allegations:
This complaint is filed under the Salina City Code, Chapter 13, Equal Opportunity and Affirmative Action Ordinance.
Sec. 13-83. Submission of a false, misleading or incomplete complaint, statement, response or report states:
“Any person who knowingly and intentionally submits or files or causes to be submitted or filed, a false, misleading, or incomplete complaint, statement, response or report with the commission, the director or any of the department’s personal, shall be guilty of a misdemeanor."