File a Public Accommodation Complaint

Page X of X Z questions on this page

Required fields are marked with a red asterisk.

  • If you do not know the answer, type “Unknown”.
  • If the field does not apply to you, type “NA”.
You must complete the entire form to submit it. This form cannot be saved for later.

Disclaimer

The Louisiana state law LA R.S. 51:2247 says it’s illegal to deny someone the full and equal enjoyment of the goods, services, facilities, privileges, advantages, and accommodations of a place of public accommodation, resort, or amusement, on the grounds of

  • race
  • creed
  • color
  • religion
  • sex
  • age
  • disability
  • or national origin.

Complete this form only if you believe you have been discriminated against because of one of these reasons. Please take your time to answer all questions completely and accurately.

  • This form has a total of # questions and # are required.
  • Additional questions can become required based on your answers.

The Louisiana Commission on Human Rights can only investigate discrimination that happened within the past year (365 days). When we get the form, we'll review it to determine if we can get involved. If you have difficulty understanding these instructions or have questions, contact our office at (225)342-6969, and a member of our staff will assist you.

Required Evidence

  • Keep in mind the burden of proof is on you. Your evidence is important and helps determine the outcome of the complaint.

After you fill out the Public Accommodation complaint form, we will need information from other people and some extra documents to investigate your complaint. Our form asks questions about the people and documents that might help prove that any mistreatment you experienced. To be most useful to your complaint, the people you identify generally should have direct knowledge of how you were treated and/or information about how your treatment compared to that of other people. This form asks for the basic information that we need to decide whether or not we can investigate your public accommodations - related problem. Completing this form does not mean you have filed an official discrimination complaint.

You can download a paper version of the Accommodation Complaint form if you prefer to fill it out by hand.

Check If You Qualify

Home

Personal Information

Alternate Contact Information

If we cannot reach you directly, who can we contact to help us reach you?

Organization

What organization (e.g. store, restaurant, city government agency) do you believe has discriminated against you?

Discrimination Complaint

What is the reason (basis) for your claim of discrimination? What happened to you that you believe was discriminatory?

Check all that apply.

Disability Discrimination

Provide answers for this section if you have a disability or a disability relates to the discrimination claim.

Check all that apply.
Does this disability prevent or limit you from doing anything such as lifting, sleeping, breathing, walking, caring for yourself, working, etc.? If so, how does this disability affect you?
Please provide the full name of the person.

Similarly Situated

Use the section below to describe who was in the same or similar situation as you. How were they treated? For example, who else requested service from the organization? Tell us the reason they said they suffered discrimination, if you know it, and it relates to what you suffered. For example, if your complaint is about race, tell us the race of each person.

Provide all details of the person who was in the same situation as you.

Provide all details of the person who was in the same situation as you.

Provide all details of the person who was in the same situation as you.

Witnesses

Tell us about any witnesses, if any, to the discrimination.

Provide all details of the witness.

Provide all details of the witness.

Provide all details of the witness.

Previously Filed Complaints or Assistance

Tell us about any other complaints you’ve filed, whether with us or another agency, or about any assistance you’ve received about this complaint.

Signature and Date

I declare under penalty of perjury, under the State of Louisiana, I certify that all statement contained in this Intake Form and all accompanying documents are true and correct to the best of my knowledge and belief.

By typing your full name in the field above, you are electronically signing the information provided by your responses.

Complainant’s Consent for Investigatory Use of Personal Information.

  1. I understand that I am not required to give personal information to the LCHR; however, my complaint may be closed if I refuse to supply information needed to investigate my complaint;
  2. I understand that it is my duty to update the personal information I supply and failure to do so may result in my complaint being closed;
  3. I understand that I may receive a copy of any personal information I submit, if I request it;
  4. I understand the information provided by me may have to be released under the Public Records Request Act under LA R.S. 51:2262 (F): The law makes it unlawful for the Louisiana Commission on Human Rights to make public with respect to a particular person, without his consent, information obtained by the Commission pursuant to its statutory authority; and
  5. I authorize the release of my submitted information in accordance with R.S. 51: 2262 (F).

Based on the foregoing, I hereby give my consent to the Louisiana Commission on Human Rights to process my complaint.

By typing your full name in the field above, you are electronically signing and acknowledging that you agree to the information above.