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Human Relations Commission

10 North 2nd St. Suite 303 Harrisburg, PA 17101


Document Signers
    • 1 Signer 1

    • 2 Shaashawn Dial

Form Section 1

HHRC Discrimination Report Form

Personal Information

Discriminatory Information

In which area(s) have you experienced discrimination? Check all that apply.
Indicate the Protected Class(es) under which you fall that may have resulted in discriminatory treatment. Leave the field blank or mark N/A if you believe the category is unrelated to your report.
Have you made an attempt to resolve the issue through any grievance procedure (Supervisor, Harrisburg City Management, Public or Private Organization)?