Incident Report / Discrimination Claim

ADC Michigan receives hundreds of complaints per month and appreciates your patience when filing a complaint.  ADC's policy is to answer complaints in the order they are received unless matters of urgency occur. (e.g. deportation, threats to human life, and/or matters of current events)

How to File a complaint

To send a complaint, please fill out the below form describing the details of the event including parties involved, contact information of the involved party (if available) and personal contact information where you can be reached.  Also please note if a complaint in a civil court has been filed and if an attorney is representing you.

You may also print this form and mail or fax a typed letter to the below address:

ADC Michigan
Att: Legal Advisor
13530 Michigan Ave., Suite 329
Dearborn, MI 48126
Fax: 313-581-1604

Online Form

Your Information

Full name: *

Address: *

City: *

State: * AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip code: *

Telephone: *

E-mail: *

Incident Information

Discrimination Category: *

Employment

Religious

Education

Entertainment

Media

Law Enforcement

Other

Cause and Reason for Discrimination: *

Race

Color

Gender

Age

National Origin

Religion

Other

Date of Incident: *

MonthJanFebMarAprMayJunJulAugSepOctNovDec

Day12345678910111213141516171819202122232425262728293031

Year20102011201220132014

Time of Incident: *

hour123456789101112

:

minute000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859

am

pm

Parties Involved:

Location of Incident:

Attorney Information

Have you been in contact with an attorney: *

Yes

No

If yes, please supply the attorney’s name and information:

What code is in the image?: *

Enter the characters shown in the image.