STATE OF KANSAS
KANSAS HUMAN RIGHTS COMMISSION
We are providing this complaint form, instructions, and supplemental information form as a service to the public.
However, we encourage individuals wishing to file complaints with the Kansas Human Rights Commission (KHRC) that
fall within the jurisdiction of the Kansas Act Against Discrimination and/or the Kansas Age Discrimination in
Employment Act to contact our Intake Unit. Intake staff can draft a complaint for you. Intake staff can be reached at
(785) 296-3206, toll free at 1-888-793-6874, or at (TDD) (785) 296-0245 during State of Kansas workdays from 8:00
a.m. to 5:00 p.m.
If you wish to start the employment complaint intake process at a time when KHRC offices are closed, we provide a
quick and easy on-line questionnaire. It is available on our main webpage at www.khrc.net. Scroll down to the red link
of “Interested in filing an employment complaint? Start the process an online questionnaire. Click here.”
Instructions
If you are under 18 years of age, a parent or guardian may file for you.
Part 1 Instructions: Selecting Base(s) (Protected Classes):
Please select the base(s) (protected classes) that you feel best describes the reason(s) for the alleged discriminatory
action(s) and/or harassment by doing the following:
Please check the box(es) beside the Kansas Act Against Discrimination and/or the Kansas Age Discrimination
in Employment Act. Age is only for employment complaints and when the Complainant is age 40 years old
or older. Please complete the fillable box for your age if applicable.
If you are filing under the Kansas Act Against Discrimination for an employment, housing or public
accommodations complaint, please check one or more of the bases (protected classes). Sex includes gender,
pregnancy, sexual orientation, and gender identity. Genetic Information is only for employment
complaints. Familial Status (having children or grandchildren under the age of 18 live with you) is only for
housing complaints. Depending upon which bases (protected classes) you select, there may be either a drop
down box or a fillable box beside the basis to provide additional information.
Part 2 Instructions: Alleged Date(s) of Incident(s): The alleged incident(s) must have occurred in the last six
months for employment and public accommodation complaints. If there are multiple incidents, they must not be
more than six months apart. For housing complaints, the last alleged incident(s) must have occurred within the last
year.
Part 3 Instructions: Charges Based on the Following Facts: Please provide a description of the adverse action(s)
or the harassment that you allege has occurred due to the base(s) you selected. Please provide the title(s) of the
person(s) you allege discriminated against you or harassed you. Please list your job title and when you were hired if
this is an employment complaint.
Please date and sign the complaint on the line marked by an “X”.
Submit Your Signed Complaint and Supplemental Information to the Kansas Human Rights Commission:
Kansas Human Rights Commission
Attn: Intake Unit
900 S.W. Jackson, Suite 568S
Topeka, Kansas 66612
If you choose to submit a copy of a signed complaint by e-mail, facsimile, or mail, you are expected to retain the
original, signed complaint in your records for production to the KHRC upon request.