Disability Information Release for Education

Complete this form if you have a disability-related complaint.  This form authorizes the release of information related to your disability to PA Human Relations Commission investigators. 

Retaliation Questionnaire

Complete this form if you were disciplined, expelled, or treated differently in the terms or conditions of your education because you filed a complaint with the PA Human Relations Commission, assisted in an investigation, or otherwise opposed illegal discrimination.

General Questionnaire

Complete this form if you have been discriminated against by an elementary or secondary school; college or university; vocational, professional, business, secretarial or trade school based on your race, sex, ancestry, religion, disability, etc.  This includes discrimination by classmates, teachers, administrators or other personnel, or in the admissions process.

Failure to Accommodate a Disability

Complete this form if a failure to provide appropriate accommodations for a physical or mental disability has negatively affected or denied your education. (sign language interpreter denied, service or assistance animal not allowed, screen reader or other assistive device refused, etc.)

Accessibility Questionnaire

Complete this form if your education was negatively affected or denied by lack of physical access to the educational facility. (barriers to wheelchair access, no ramp, etc.)

Harrassment Questionnaire

Complete this form if you were persistently harassed, coerced or intimidated based on your sex, race, religion, ancestry, disability, etc. in an educational institution.