Civil Rights Complaint form draft

Please complete this form to file a Civil Rights complaint with the Washington Department of Natural Resources.



Contact Information

*Indicates Required Fields

Submitted by Value

First Name *

Last Name *

Address

City

State

ZIP

Email (Required)





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Question 1 of 10

Today's Date

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Question 2 of 10

Phone number

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Question 3 of 10

Are you filing a complaint for yourself or on someone else's behalf?

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  • Myself
  • Someone else

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Question 4 of 10

Please explain the incident

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Question 5 of 10

Date of the incident

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Question 6 of 10

Time the incident occured

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Question 7 of 10

Address or GIS location where the incident occured

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Question 8 of 10

How would you like us to communicate with you?

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  • Email
  • Phone

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Question 9 of 10

If DNR employees were involved, please provide their names

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Question 10 of 10

Please upload any supporting documents, photos, or video recordings

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