Request For Withdrawal Of Charge Of Discrimination

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REQUEST FOR WITHDRAWAL OF CHARGE OF DISCRIMINATION
This form is provided for persons who wish to withdraw their charge. In order to initiate
such action, please furnish the information below and return this to the Iowa Civil Rights
Commission.
Please note that your charge is presently open with both the Iowa Civil Rights
Commission (ICRC) and the Equal Employment Opportunity Commission (EEOC). If you
desire to withdraw your charge with both agencies, it will be necessary to so indicate in
the space provided below.
Since a request for withdrawal of a charge is subject to the
approval of the agencies named above, your request will be considered and acted upon
when received.
Please note that both agencies are still prepared to proceed with your
charge if you so desire.
Charging Party Name:
Respondent (s) Name:
FEP Agency Charge #:
EEOC#
CHARGING PARTY COMPLETE INFORMATION BELOW (Continue on reverse if necessary)
I am aware that the EEOC and the ICRC protect my right to file a complaint.
I have
been advised that it is unlawful for any person covered by Title VII of the Civil
Rights Act of 1964, as amended, to threaten, intimidate or harass me because I have
filed a complaint. I have not been forced to request this withdrawal.
____(Check if appropriate): Also, I have been advised that it is unlawful for any person
covered by the enabling legislation of the ICRC to threaten, intimidate or harass me
because I have filed a com plaint.
I request the withdrawal of my charge because:
I wish to withdraw my charge filed with the Iowa Civil Rights Commission
(signature)
(date)
I wish to withdraw my charge with the Equal Employment Opportunity Commission.
(signature)
(date)
______________________________________________________
SEND TO:
For EEOC use Only
*___approve___disapprove
*Director______________
*Date_________________

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