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UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF INDIANA __________________ DIVISION
_____________________________, Plaintiff, vs. _____________________________, Defendant. ) ) ) ) ) ) ) ) )

Cause No.

COMPLAINT UNDER TITLE VII FOR DISCRIMINATION
Plaintiff brings a complaint against defendant ____________________ for violation of Title VII rights. Plaintiff ____ DOES ____ DOES NOT (indicate which) demand a jury trial.

I. PARTIES
Plaintiff's Name, Address and Phone Number: _______________________________ _______________________________ _______________________________ _______________________________ Defendant's Name and Address _______________________________ _______________________________ _______________________________ _______________________________

II. JURISDICTION
1. This complaint is brought pursuant to Title VII of the Civil Rights Act of 1964, as amended, and jurisdiction is based on 42 U.S.C. §2000e-5 and 28 U.S.C. §1331. 2. Plaintiff ____ DID ____ DID NOT (indicate which) timely file a charge of discrimination with the Equal Employment Opportunity Commission. [Attach charge as Exhibit 1].

3. Plaintiff's Right to Sue Notice from the Equal Employment Opportunity Commission was received on or about __________________________ (insert date). [Attach Notice of Right to Sue as Exhibit 2].

III. FACTS IN SUPPORT OF COMPLAINT
The facts on which this complaint is based are the following: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

IV. STATEMENT OF LEGAL CLAIM
Plaintiff is entitled to relief in this action because: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

V. PRAYER FOR RELIEF
Based on the foregoing, plaintiff seeks the following relief:

(Use additional sheets if necessary.)

VI. AFFIRMATION OF PLAINTIFF
I, the plaintiff in the aforementioned cause, do affirm that I have read all of the statements contained in the complaint and that I believe them to be, to the best of my personal knowledge, true and correct. Signed this _______ day of _____________________, 20__.

__________________________________ (Signature of Plaintiff)