Legal Division
DeKalb Human Relations Commission Complaint Form

Instructions:

            This form is used by the City of DeKalb Human Relations Commission to investigate discrimination complaints.  The DeKalb Human Relations Commission operates under Chapter 49 of the City of DeKalb Municipal Code.  Chapter 49 prohibits discrimination in real estate, financial transactions, public accommodations and employment based on race, creed, color, gender, religion, age, national origin or ancestry, physical or mental disability, marital status, matriculation or sexual orientation.

            Please fill out the form as completely as possible using the spaces provided.  If necessary, you can also attach additional information to this form.  All information on this form will be kept confidential by the Human Relations Commission while the complaint is being investigated.  However, the Respondent will receive a copy of this complaint.

            When the complaint is received, the Commission will appoint an Investigative Team made up of Commission members to investigate the complaint.  The team will be in contact with you and the person or organization the complaint is being made against in an attempt to resolve the complaint. If the complaint is not resolved by the team’s investigation and if the team believes that discrimination has taken place, a public hearing can be called by the Human Relations Commission. If the Human Relations Commission believes that Chapter 49 has been violated after a public hearing, charges against the person or organization may be filed in Municipal Court.

            If additional information is needed regarding this form or the process followed by the Human Relations Commission, or if assistance in filling out the complaint is needed, please contact the Assistant City Attorney at 200 South Fourth Street, DeKalb, Illinois. (815)748-2093.

Please fill out the following information, and click on the "submit" button.

File Date: 

Name-(Required)
First Name: Middle Initial:   Last Name: 

Address-(Required)
Number:  Street:

 City:  State:  Zip:-

Business or Other Address
Number:  Street:


Home Phone (Required)   --  Work Phone (Required)  --

Discrimination involves area of:
Housing     Financial Institution     Employment     Public Accommodation     Other (specify)  

Basis of discrimination:  (Check all that may apply)
Race, Creed or Color     Gender     Religion     National Origin or Ancestry     Disability
Age (18 & over)     Marital Status     Matriculation     Sexual Orientation     Other  (specify) 

Name, address and phone number of  person(s) you believe discriminated against you:
Name: 

Number:  Street:
Title: (Owner, manager, clerk, bartender, etc.)
Phone #:--

Name of establishment or agency:
 

Address of establishment or agency:

Number:  Street:

City:   State:   Phone#: --    

Date and time of incident(s):
 

Where did the incident(s) occur?: 


Name of individual(s) who may have been a witness or aware of the incident(s):

Fully describe the incident(s) as clearly as possible (attach additional pages if necessary):

If in the course of the investigation of the complaint, the Commission needs access to confidential or privileged records, does the Commission have your permission to use these materials?

Yes   No

I hereby certify that the information I have provided in this complaint is true, correct, and complete to the best of my knowledge and belief.

Complainant Signature (Fill out name if completed on website):
    

Date:

Local Agencies:
DeKalb Police Department…………………………………………(815)748-8400
Emergency Number (when a crime has been committed)……..911
Rape Crisis Line……………………………………………………(815)758-6655
Kishwaukee Hospital E.R./Rape Crisis Center……………………(815)756-1521 Ext. 3491

STATE AND FEDERAL AGENCIES:
Illinois Department of Human Rights
State of Illinois Center
100 West Randolph Street
Suite 10-100
Chicago, IL  60601         (312) 814-6200  
(Complaint must be made within 180 days of the occurrence.)

Federal Equal Employment Opportunity Commission
536 South Clark Street
Chicago, IL  60607          (312) 353-2713  
(Complaint must be made within 300 days of the occurrence.)

Thank you for your assistance and concern. 
By selecting "Submit", this form is sent directly to the Assistant City Attorney's desk. 
If you wish, you may print this form, and mail it to:

Dawn Didier-Asst. City Attorney
Attn: HRCCF
City of DeKalb Municipal Building
200 S. Fourth St.
DeKalb, IL 60115