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2. Contact Information [Optional]

   Please share contact information if you wish to be contacted pertaining to what you are sharing here.

4. Name
5. Email Address
7. Address
9. City
10. State
11. Zip Code
13. Phone Number
14. Fax Number
16. Why do you believe your rights were violated?

    1. Race
    2. Ethnicity
    3. Color
    4. Religious views
    5. National origin
    6. Citizenship

    1. Age
    2. Ancestry
    3. Family/marital status
    4. Disability
    5. Military status

    1. Source of income
    2. Sex
    3. Sexual orientation
    4. Gender identity or expression
    5. Other
18. Narrative
20. File Upload [Optional]

    Please attach any images relevant to your narrative

22. What would you like to see happen?

24. Please note that all correspondence with the Town of Danvers are public and are subject to public records laws unless an exemption exists. You can also call to speak confidentially with the Director of Equity and Inclusion for more information.

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26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

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