Iowa Civil Rights Commission

Authorization Release Form

Iowa Civil Rights Commission
Grimes State Office Building
400 East 14th Street
Des Moines, Iowa 50319-1004
515-281-4121
800-457-4416
FAX 515-242-5840
http://www.state.ia.us/government/crc

 

I hereby authorize anyone possessing medical, education, personnel, income, credit, or any other information necessary for a full and complete investigation, mediation, or conciliation of my complaint to furnish such information to the Iowa Civil Rights Commission and any other anti-discrimination agency.


I hereby release anyone so authorized, the Iowa Civil Rights Commission, and any other anti-discrimination agency from all liability for any damages whatsoever in furnishing and obtaining such information.

 

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Signature

 

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Social Security Number (voluntary)

 

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