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COMPLAINT FORM
ACLU OF OKLAHOMA
3000 Paseo Drive
Oklahoma City, OK 73103
(405) 524-8511
NAME: _____________________ DATE: _______________
ADDRESS: ______________________________________
CITY: ____________________ STATE: ____ ZIP: _______
DAYTIME PHONE: ________ EVENING PHONE: _________
NATURE OF COMPLAINT:
___ Freedom of Speech, Press and/or Assembly ___
Due Process
___
Right to a Lawyer ___ Freedom of Religion ___ Church/State
___ Privacy ___ Student Rights or Academic Freedom ___ Military Issues
____ Equal Protection based on: __ Gender __ Race __ Age
__ National Origin __ Immigrant Status __ Mental Health
__ Prison Reform __ Police Misconduct
__ Physical Disability
__ Sexual Orientation
COMPLAINT AGAINST: (Specify name, address, phone,
official title or
agency, if any) ________________________
________________________________________________
MAY WE CONTACT THIS PERSON OR AGENCY? ___Yes ___No
DESCRIPTION: (Describe situation surrounding complaint.
Be specific,
if possible, including names, dates, etc.). Use
additional
pages if needed.
PLEASE DO NOT SEND ORIGINAL
DOCUMENTS IN SUPPORT OF COMPLAINT. ALL
DOCUMENTS
SUBMITTED BECOME THE PROPERTY OF THE
ACLU AND
WILL
NOT BE RETURNED.
________________________________________________
________________________________________________
WITNESSES: (Give name, address, and phone number.)
________________________________________________
________________________________________________
________________________________________________
EVIDENCE: (Describe and attach copies, NOT ORIGINALS, of
documentation available) __________________________
_______________________________________________
HAVE YOU: (Please circle one, give details if possible)
Yes No Filed complaint with another agency or court?
Where:
_____________________
Yes No Obtained representation by an attorney?
Who:
_____________________
Yes No Become aware of time limitations in your case?
When:
_____________________
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