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:

 

Nature of dispute with company:

 

If harassment, have you complained to your workplace superior:

 

Explain your dispute (if terminated, give date):

 

 

 

Have you filed a complaint with the EEOC, THRC or other administrative agency:

 

                What date did you file your EEOC Complaint:

               

                If "yes" above, have you recieved a "right-to-sue" notice:

 

 

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

 

 

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