Pursuant to Olathe Municipal Code (O.M.C.) 2.43.040, this form is provided for persons to file a complaint regarding an unlawful discriminatory practice that is prohibited by O.M.C. Chapter 2.43.

New Text Information

1

Complainant's Full Name

 *

Complainant's Full Name

First Name

Last Name

2

Contact Information

 *

Contact Information

Street Address/PO Box	City
State(Select State) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming	Zip Code
Email Address	Phone Number ext.

3

Person alleged to have committed discriminatory act(s)

 *

Person alleged to have committed discriminatory act(s)

First Name

Last Name

4

Person or entity you are complaining about. (if different from above)

 *

Person or entity you are complaining about. (if different from above)

First Name	Last Name
Organization

5

Description of unlawful discriminatory practice

 *

Description of unlawful discriminatory practice

6

 I understand this document and information I have submitted is subject to the Kansas Open Records Act and would be produced as such upon request. 

 *

Yes

7

I affirm this statement is true and accurate to the best of my knowledge.

 *

Yes

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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