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Complaint Form

Recently, our chapter has experienced a slight increase in the number of complaints emailed to us. Some of these complaints were within ACLU's general mission and some where not. In order to better process these complaints and acquire more relevant information that will help our sorting process we've decided to adopt the NC-ACLU's complaint form and put it on our web site. Below this statement are the NC-ACLU's instructions on filling out this form. Keep in mind that not all fields will apply to you since the complaint form was originally created to accommodate the general public's, not NCSU's, needs. Once you have filled it out, the form will be sent to the NCSU chapter, NOT the NC chapter. We, ACLU chapter at NCSU, will respond to your complaint within a week by email. If we decide that your complaint is valid and our chapter is capable of dealing with it, we will proceed by directly contacting you to set up an interview. If your complaint is valid and can be better handled by the NC-ACLU we will inform you of this and proceed by forwarding your complaint to the NC-ACLU by mail.

Please read the instructions below and provide as much information as possible.

If you are NOT an NC State faculty, staff or student please do NOT fill out this form and proceed by directly contacting the North Carolina ACLU.



ACLU Complaint Intake Information

This ACLU of North Carolina complaint form is designed to assist the ACLU in the evaluation of your grievance. When filling out this form, please be as specific and detailed as possible. It is important that all questions be answered fully and completely.

The ACLU of North Carolina is interested in redressing violations of civil liberties It is our mandate to serve those who have been denied their fundamental rights, usually by some governmental entity.

Unfortunately, our resources are limited. We take cases that raise significant constitutional or civil liberties issues and which impact others in the same situation. We cannot take all cases offered us.

The ACLU of North Carolina has limited resources and must concentrate them where they are most needed. We are unable to take many cases, even those concerning real injustices. If your complain is not pursued by our office, it does not mean it is without merit.

If we need further information, we will have your address and/or telephone number once you fill out and mail this form. We can then request any documents necessary. We only consider cases in which the incident complained occurred in North Carolina .

We will be responding to your complaint in writing within 2-4 weeks of receipt. If you do not hear from us within four weeks, feel free to contact us.

** Although we keep our files confidential, submitting cases via e-mail to aclunc@z-wave.net is not a secure means of transmission. If you do not wish to submit your form via e-mail, you may print out this form, fill it out and mail it to the postal address below:

ACLU of NC

P.O. Box 28004

Raleigh , NC 27611


1. COMPLAINANT INFORMATION
Your full name:

Your email address: (e.g.: you@aol.com)

Address

City

State

Zip Code

County

Daytime Telephone

Evening Telephone

2. MY COMPLAINT IS AGAINST THE FOLLOWING: Name

Agency

Address

City, State, Zip Code:

County

Phone

May we contact this person?

3. DATE OF SITUATION GIVING RISE TO YOUR COMPLAINT

4. WITNESSES OR PERSONS WITH INFORMATION REGARDIGN YOUR COMPLAINT

Name

Address

City, State, Zip Code


May we contact this person?

5. HAVE YOU FILED A COMPLAINT WITH ANY OTHER AGENCIES?

If yes, please describe in the following space and include dates.

6. IF YOU ARE A PRISONER OR DETAINEE, OR ARE WRITING ON BEHALF OF A PRISONER OR DETAINEE, WHO HAS A COMPLAINT CONCERNING THE CONDITIONS OF YOUR CONFINEMENT OR DETENTION, YOU MUST EXHAUST ALL GRIEVANCE PROCEDURES BEFORE CONTACTING US. In addition, NC Prisoner Legal Services, Inc. has attorneys whose primary purpose is to represent prisoners with legal claims. You may contact NC Prisoner Legal Services at P.O. Box 25397, Raleigh, NC 27611. or by calling (919) 856 - 2200. If you have a complaint specifically related to the exercise of your First Amendment rights while in jail, please describe your situation below.


7. ARE YOU REPRESENTED BY AN ATTORNEY IN THIS MATTER? IF SO, PLEASE HAVE YOUR ATTORNEY WRITE TO US SUMMARIZING YOUR CONSTITUTIONAL LEGAL CLAIMS.

Please fill in the following:

Attorney's Name

Address

City, State, Zip Code:

County

Phone

8. HAS A CRIMINAL OR CIVIL LAWSUIT BEEN FILED AGAINST YOU OR ON YOUR BEHALF? IF SO, PLEASE PROVIDE THE FOLLOWING:

Case Number

Case title

Date of filing

Court with jurisdiction

Judge

Opposing Counsel

Current status of the case:

9. COMPLETE DESCRIPTION OF COMPLAINT: Please describe IN DETAIL, in a brief summary, all the events that led you to file this complaint. If you have additional documents to support your description, please print out this form and mail it along with other pertinent information, to the address below: address here. (If you need more space to describe your situation, attach more pages)


10. Please state clearly what you would like the ACLU at NCSU to do for you:


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