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AURORA HUMAN RELATIONS COMMISSION COMPLAINT FORM
This form will be used by the City of Aurora Human Relations Commission to investigate discrimination complaints. The Aurora Human Relations Commission operates under Chapter 22 of the City of Aurora Municipal Code.
Instructions: Please complete the form to the best of your ability using the space provided. If necessary, you may attach additional page(s) to this form. After the complaint is received, the Commission will investigate the complaint. You and/or the person/organization against whom the complaint is being made may be contacted in an attempt to resolve the complaint. If the complaint is not resolved by the investigation and if the Commission believes that discrimination may have taken place, a public hearing may be called by the Human Relations Commission to resolve the complaint. If the issue is not resolved at the public hearing, the Commission may continue to investigate. The Commission will reach a final decision regarding the complaint and will report its decision to you.
First Name:*
(MR/MRS/MS) Your First Name
Last Name:*
Your First Name
Address:*
Address
City:*
City
State:*
Zip Code:*
Zip Code
Business or other Address:
Please enter any other address - Street, City, State, Zip
Phone Number:
Primary Phone
Other Phone:
Other Phone
Email Address:
Vaild Email address
In your opinion, on what basis were you discriminated?
1. National Origin or Ancestry
2. Physical or Mental Disability
3. Gender or Gender Identity
4. Race or Color
1. Age
2. Marital Status
3. Religion or Creed
4. Other
If other, please explain:
Please identify the person(s), business, or company you believe discriminated against you:
First Name:*
First Name
Last Name:
Last Name
Address
Address
City:
City
State:
Zip Code:
Zip Code
Phone Number:
Primary Phone
Other Phone Number:
Other Number
Additional contact information (if any):
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Step Two

1) Please tell us what happened. Clearly share how you think discriminated took place in the space provided below and be as specific as possible. For instance, list the date and time of day, all persons present, and any specific things that occurred or language used. (If necessary, you may attach additional information to this form.)*
2) What is the most recent date on which the alleged discrimination occurred? *
2) What is the most recent date on which the alleged discrimination occurred?
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Step Three

3) Please share any steps already taken, if any, concerning this matter. (for example, “talked to my union representative,” “talked to a lawyer,” “filed a complaint with the Illinois Dept. of Human Rights”, etc.)*
Discrimination Involves: (please check all that apply)*
1. Housing
2. Employment
3. Access to a service or place open to the public
4. Other (Specify in area to right)
Other - Please Specify:
Electronic Signature Agreement*
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
1. I agree.
Electronic Signature*
Date*
Date
The Human Relations Commission will contact you to confirm receipt of this form. If you are not contacted within two (2) weeks of submission, please contact the Chairperson at 630-256-3007.
Information on this form will be kept confidential by the Human Relations Commission while the complaint is being investigated. Please note this form and any investigative materials and/or reports will be released upon proper request subject to the Illinois Freedom of Information Act or valid court order.

Leave This Blank:

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

This field is not part of the form submission.
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