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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)? *