This form is not intended for emergency purposes. If you need to report an emergency where someone is at immediate risk of harm, please call 911.
If you feel you have been discriminated against and the discrimination occurred within the City of Edina with the last 365 days, please complete this form or contact Race and Equity Coordinator, Heidi Lee, by email at hlee@EdinaMN.gov or by phone at 952-826-1622.
You can also contact the Minnesota Department of Human Rights (MDHR) by calling 651-539-1133 or toll free at 1-800-658-3704 or by email at firstname.lastname@example.org.
The purpose of this form is to monitor to potential bias and discrimination incidents that occur within the services, facilities, and institutions in the City the Edina government. Submitting this is making the City aware of incidents and submission of this form may or may not result in criminal or city action.
Anyone who has experienced, witnessed or learned of a potential bias incident within 365 days of form completion date.
The submitted form is routed to the appropriate City of Edina staff member. Every effort will made to review the report promptly; however, the timing and action of the City to respond to the report will vary depending on the information provided. Submission of this form will likely result in a staff person contacting you to discuss the situation and gather additional information, so please make sure to provide accurate contact information.
Provide a current email address that can be used to contact you.
Check all that apply
If you checked "Other" under Nature of Bias, please describe in a few words. We'll ask for details later in this form.
If you don't recall exactly, please take your best guess.
If you selected "Other" for Type of Incident, please describe it in a few words.
If the incident appears in or is related to a social media post or website, please provide the link (full URL) or links involved.
If you have photos, documents or other files related to this incident, please upload them.
If you are unable to upload a file or don't have it in digital form but would be willing to provide it to us, please check the below box. We will ask about it when contacting you.
Information you provide on this form is subject to public data laws. Any public information would be released upon request. By completing this form, you are consenting to this information being shared with staff to determine action needed and for staff to contact you. You may choose not to provide some or all of this information, but it may limit staff's ability to assist you or address the issue.
This field is not part of the form submission.
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