That you bring the completed questionnaire with you to this office to discuss your situation 2025

1. Click ‘Get Form’ to open the Intake Questionnaire in our editor.
2. Begin with your Personal Information. Fill in your last name, first name, middle initial, and contact details including your address and phone numbers.
3. Answer the questions regarding your disability status and demographic information. Be sure to check all applicable boxes.
4. In Section 2, indicate the organization(s) you believe discriminated against you. Provide their contact information and specify if you worked from home.
5. Complete Section 3 with your Employment Data, including dates of hire and job titles. If applicable, indicate if you are a federal employee.
6. Detail the basis for your discrimination claim in Section 4 by checking relevant boxes and providing explanations where necessary.
7. In Sections 5 through 8, describe the discriminatory actions taken against you, including dates and names of individuals involved.
8. Finally, review all sections for completeness before signing at the end of the form. Attach any additional pages if needed.

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