100 years

Hawai‘i Community Foundation
Title VI/504/ADA and Related Statutes Discrimination Complaint Form

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TITLE VI/504/ADA and Related Statutes Discrimination Complaint Form

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Date and place of alleged discriminatory actions. Please include earliest date of alleged discrimination and most recent date of discrimination:

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How were you discriminated against? Describe the nature of the action, decision, or conditions of the alleged discrimination. Explain as clearly as possible what happened and why you believe your protected status was a factor in the discrimination. Include how other persons were treated differently from you.

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Names of persons (witnesses, fellow employees, supervisors, or others) whom we may contact for additional information to support or clarify: