City of Detroit - Civil Rights, Inclusion & Opportunity (CRIO) CLAIMANT QUESTIONNAIRE - Intake Form

Please complete this form to start the process of investigating your claim of a discrimination or harassment violation.

All claims of violations must occur within the City of Detroit limits.
The claim of a violation must have occured within one year of the date of this completed Claimant Questionnaire.


Your Name




Please indicate the best number to contact you.


Please provide the best email address to contact you




Person or agency you are alleging discrimination or harassment against



















Please complete this section if your claim of discrimination is for your employer.


















Complete this area to detail the incident or action that lead to you filing this claimant questionnaire.








Please give contact information for all your witnesses that may help prove your claim of discrimination


This signature certifies that the information that was provided is true and verifiable.


Enter today's date






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