DHRC PACKET - CANCELLATION NOTICE

Dover Human Relations Commission Meeting Agenda March 19, 2020 - 6:00 p.m. In the interest of proper health and safety practices, this meeting has been canceled. All agenda items will be moved to the next Dover Human Relations Commission Meeting. City Hall Council Chambers, 15 Loockerman Plaza, Dover, Delaware Public comments are welcomed on any item and will be permitted at appropriate times. When possible, please notify the City Clerk (736-7008 or email at cityclerk@dover.de.us) should you wish to be recognized. Adoption of Agenda 1. Community Collaboration - National Association for Advancement of Colored People (NAACP) (Anne Smith) 2. Discussion - Intake Form - Revisions and Disbursement 3. Adjournment by 7:00 p.m. To assure that there will be a quorum, please RSVP by contacting the City Clerk's Office by email at cityclerk@dover.de.us or by calling 736-7008 as soon as possible. /JT S:\AGENDAS-MINUTES-PACKETS-PRESENTATIONS-ATT&EXH\Misc-Agendas\DHRC\2020\03-19-2020 DHRC AGENDA - CANCELLATION NOTICE.wpd The agenda items as listed may not be considered in sequence. Pursuant to 29 Del.C. §1004(e)(2), this agenda is subject to change to include the addition or deletion of items, including executive sessions, which arise at the time of the meeting.

CITY OF DOVER HUMAN RELATIONS COMMISSION PUBLIC ACCOMMODATIONS DISCRIMINATION INTAKE FORM INSTRUCTIONS This packet contains the form you will need to complete to begin the process of filing a discrimination complaint with our office. You can also download and print this form from our website: https://www.cityofdover.com/dhrc. The form asks for some of the basic information that we need to decide whether or not we can investigate your public accommodations-related problem. If you have difficulty understanding these instructions or have questions, our staff can assist you. The Public Accommodations Discrimination Intake Form asks questions about why you believe you were treated unfairly and how you believe this treatment was against the law. In the City of Dover, the law protects individuals against unfair treatment in public accommodations on the basis of:  Ancestry  Marital Status  Color  National Origin  Disability  Race  Domestic and Sexual Violence  Religion  Ethnicity  Retaliation for Prior Discrimination Complaint  Familial Status  Sex (including breastfeeding)  Gender Identity  Sexual Orientation The DHRC Cannot Investigate Public Accommodations Complaints Based on General Mistreatment There are many reasons people are treated unfairly, and several of these reasons may not be against the law. The DHRC can only investigate public accommodations complaints based on illegal mistreatment relating to the factors identified above. By law, we cannot handle general public accommodations-related concerns based on any other factors. In addition, your complaint should relate to mistreatment that affected you personally. You cannot file a complaint about the treatment of someone else unless you have the legal right to represent that person (e.g., because you are the person’s parent or guardian). Evidence Is Required To Support Your Discrimination Complaint In addition to the statements you make about why you believe you were mistreated, the DHRC will need information from other people and from documents to investigate your complaint. The Public accommodations Discrimination Intake Form includes questions about the people and documents that might help prove that any mistreatment you experienced was against the law. To be most useful to your complaint, the people you identify generally should have direct knowledge (have learned through their own senses) of how you were treated and/or some information about how your treatment compared to that of other people. The most helpful documents will be ones written around the time that you believe you were mistreated. Complete the attached form only if you believe you have been discriminated against because of one of the bases listed above. Please take the time to answer all questions completely and accurately. Once you have completed the form, please submit the form in person or by mail to our office: City of Dover Human Relations City Hall 15 Loockerman Plaza Dover, DE 19903 Phone: 302-736-7008 Fax:302-736-5068 Once we have received your completed form, our intake staff will meet with you about filing a complaint. Completing the enclosed form does not mean you have filed a discrimination complaint. A DHRC staff person will review your form and meet with you to decide if we can assist you. Preparing and filing a discrimination complaint is a complex matter. Please plan for the process to take at least 2 hours. Page 1 of 5

SPECIAL INSTRUCTIONS IF THE DISCRIMINATION WAS 9 OR MORE MONTHS AGO: The City of Dover Human Relations Commission can only investigate discrimination that occurred within the past 300 days. If your complaint involves events that occurred more than 9 months ago, please contact our office immediately. If you fail to complete all of the steps for filing a complaint within the legal time period, our staff will not be able to investigate your complaint. Page 2 of 5

CITY OF DOVER HUMAN RELATIONS COMMISSION PUBLIC ACCOMMODATIONS DISCRIMINATION INTAKE FORM 1. Please provide your personal information. First Name Last Name Street Address (Include Apartment or Unit #) City State Zip Code Email Address (if available) I Home Phone Work Phone Cell Phone Date of Birth 2. Are you filing this compliant for someone else? a. If yes, who do you believe was discriminated against? • Yes • No First Name Last Name Relationship To You 3. What organization (e.g., store, restaurant, City government agency) do you believe has discriminated? Organization Street Address City State Zip Phone Owner Name Phone 4. What is the reason (basis) for your discrimination complaint? FOR EXAMPLE: If you feel you were treated worse than someone else because of race, you should check the box next to Race. If you feel you were treated worse for several reasons, such as your sex, religion and national origin, you should check all that apply.  Ancestry  Marital Status  Color (e.g., difference in skin shade within same race)  National Origin  Disability  Race  Domestic and Sexual Violence  Religion  Ethnicity  Retaliation for Prior Discrimination Complaint  Familial Status  Sex (including breastfeeding)  Gender Identity  Sexual Orientation  Other (explain): 5. For each category above, please state how you identify yourself. For example, if you checked sex, please indicate whether you are male or female. 6. What happened to you that you believe was discriminatory? Please attach additional pages if needed. Date Action (Ex. I was denied service) Name/Title of Person(s) Responsible Page 3 of 5

7. Why do you believe these actions were discriminatory? Please attach additional pages if needed. 8. What reason(s) were you given for the acts you consider discriminatory? By whom? His or her job title? 9. Why do you believe the reason(s) given to you are false? 10. Describe who was in the same or similar situation as you and how they were treated. For example, who else requested service from the establishment? Provide the basis identified in Question 5 of these individuals, if known, and if it relates to your claim of discrimination. For example, if your complaint alleges race discrimination, provide the race of each person; if it alleges sex discrimination, provide the sex of each person; and so on. Use additional sheets if needed. a. Of the persons in the same or similar situation as you, who was treated better than you? Full Name Basis Description of Treatment b. Of the persons in the same or similar situation as you, who was treated worse than you? Full Name Basis Description of Treatment c. Of the persons in the same or similar situation as you, who was treated as same as you? Full Name Basis Description of Treatment Answer Questions 11-13 only if you are claiming discrimination based on disability. If not, skip to Questions 14-20. Please state if you have more than one disability. Please add additional pages if needed. Please check all that apply: • Yes, I have a disability • I do not have a disability, but the organization treats me as if I am disabled I do not have a disability now, but I did have one • 11. What is the disability that you believe is the reason for the adverse action taken against you? Does this disability prevent or limit you from doing anything (e.g., lifting, sleeping, breathing, walking, caring for yourself, working, etc.)? If so, how does this disability affect you? Page 4 of 5

12. Do you use medications, medical equipment or anything else to lessen or eliminate the symptoms of your disability? • Yes • No a. If yes, what medication, medical equipment or other assistance do you use? 13. Did you ask the organization for any changes or assistance to the establishment because of your disability? • • Yes No a. If yes, please state when you asked, how you asked, who you asked, what changes or assistance you requested and how the organization responded to your request. Date Verbal or Written Name/Title of Person(s) Asked Changes or Assistance Organization Response Request? Requested 14. Are there any witnesses to the alleged discriminatory incidents? • Yes • No a. If yes, please identify them below and describe what they will say. (Please attach additional pages if needed.) Full Name Address & Phone Number What This Person Will Say 15. Are there any documents about the alleged discriminatory incidents? • Yes • No a. If yes, please identify them below and indicate from whom we might obtain them. Document Source of Document 16. Have you filed a complaint on this matter with the City of Dover Human Relations Commission or another agency? • Yes • No If yes, please indicate the agency and date of filing: Agency Date of Complaint(s) • Dover Human Relations Commission I J Other (explain): Page 5 of 5

17. Have you sought help about this situation from an attorney, or any other source? Yes • No a. If yes, please provide the name of the organization, the name of person you spoke with, the date of contact, and • results, if any. Organization Person You Spoke With Date of Contact Results 18. If we cannot reach you directly, is there someone we can contact to help us reach you? First Name Last Name Street Address (Include Apartment or Unit #) City State Zip Code Email Address (if available) I Home Phone Other Phone Relationship to You I 19. Please check one of the boxes below to tell us what you would like us to do with the information you are providing on this questionnaire. If you would like to file a discrimination complaint, you must do so within 300 days from the day you knew about the discrimination. If you do not file a complaint within the time limits, you will lose your rights. If you would like more information before filing a complaint or you have concerns about DHRC’s notifying the organization about your complaint, you may wish to check Box 1. If you want to file a complaint, check Box 2. 1-• BOX 1 I want to talk to a DHRC employee before deciding whether to file a complaint. I understand that by checking this box, I have not filed a complaint with the DHRC. I also understand that I could lose my rights if I do not file a complaint in time. -• BOX 2_ I want to file a complaint of discrimination, and I authorize the DHRC to look into the discrimination I described above. I understand that the DHRC must give the organization that I accuse of discrimination information about the complaint, including my name. I also understand that the DHRC can only accept complaints of public accommodations discrimination based on ancestry, color, disability, domestic and sexual violence, ethnicity, familial status, gender identity, marital status, national origin, race, religion, retaliation for prior discrimination complaint, sex or sexual orientation. 20. If you checked Box 2 above, what would you like to have happen in response to your complaint? (Ex. use of the establishment, receipt of service requested, guarantee of no future discrimination) I declare under penalty of perjury that all of the information that I have provided on this form is true, correct, and complete to the best of my knowledge. I acknowledge that false statements on this form are punishable under state law, 11 DE. C 1953. § 1233 (unsworn falsification to authorities).? Signature Today’s Date Page 6 of 5