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Do you feel that your civil liberties have been violated? *
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Discrimination type *
On what basis do you feel that you were discriminated against?
Please describe the circumstances of the incident (location, individuals involved). Keep your description general and do not include names of anyone involved: *
Please briefly describe the injuries, damages or losses that resulted from the action(s): *
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Please indicate how you would prefer to to pay for the services of an attorney, should you hire one to help you with your legal matter. Note: there is no charge to sumbit your request.
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How Does It Work?

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