Dear Manager / Supervisor / Human Resources Officer:

I hold a position of ____________ at the company. This is a formal complaint for racial
discrimination that I have been subjected to, and my request that you investigate my
allegations and take appropriate action to stop it or remedy it. I cannot pinpoint the person's
name for sure but the following are the events that I believe constitute discrimination:
On (date)
I would appreciate the opportunity to meet with you so we could discuss this situation and
how it can be addressed.
Thank you.
(Name)