Please sign your name in the signature block on this form. LAST NAME, FIRST NAME, MIDDLE INITIAL ( ) Mr. ( ) Ms. LAST FOUR DIGITS OF SOCIAL.Please provide the required information as labeled with an asterisk so that we may contact you to discuss your request. A charge of discrimination can be completed through our online system after you submit an online inquiry and we interview you. Michigan Legal Help has tools to fill many kinds of forms but we do not cover all areas. You may have a blank form that you need to fill out on your own. Your complaint must be filed within 180 days of the discriminatory action. To initiate an inquiry because you believe someone discriminated against you in violation of civil rights laws, click the button below. This form allows individuals to file complaints regarding incidents of discrimination. If you were discriminated against at work, you can file a complaint with the MDCR.