To request a consultation, submit the following form.  You will receive a response within two business days.  For driving directions, follow this link.

About Yourself:

Full Name:

Street Address:

City:     State:     Zip:

  Phone number:

e-mail address:

Current employer:

Name: 

Street Address:

City:     State:     Zip:

Employer with whom you have a dispute:

Employer subject of complaint:

Employer Address:

City:     State:     Zip:

Date you began with Employer:      Position:

Are you currently employed by this employer: yes No

Nature of dispute with company: Sexual Harassment Other (explain below) Racial Harassment National Origin Discrimination Contract based dispute Wage and Hour Dispute (Overtime Pay) Racial Discrimination Sex based discrimination Age discrimination / Harassment Disability discrimination / harassment Religious Discrimination / Harassment

If harassment, have you complained to your workplace superior: Yes No

Explain your dispute (if terminated, give date):

Have you filed a complaint with the EEOC, THRC or other administrative agency: Yes No

                What date did you file your EEOC Complaint:

                If "yes" above, have you recieved a "right-to-sue" notice: Yes No  

                What date did you receive your "right-to sue": 

What days and hours are you available for an in-office consultation: