Navigating the complexities of withdrawing a discrimination complaint within the State of Wisconsin involves a specific procedural step facilitated by the ERD 4971 form. Provided under the auspices of the Wisconsin Department of Workforce Development's Equal Rights Division, this document serves a vital function for those wishing to retract their grievances officially. The form, rooted in the statutory provisions of Sections 15.04(1)(m) and 111.375 of the Wisconsin Statutes, outlines a straightforward but mandatory path for individuals aiming to withdraw their discrimination complaints filed with the Equal Rights Division, the U.S. Equal Employment Opportunity Commission, or the City of Madison Equal Opportunities Commission. Besides stipulating the withdrawal process, the ERD 4971 form underscores the importance of voluntary completion, while also hinting at the potential use of provided personal information for secondary purposes. Further, it reassures complainants about the unlawfulness of any retaliatory threats, intimidation, or harassment stemming from the initial complaint filing, emphasizing a protective stance towards the rights and well-being of individuals engaged in the complaint process. The careful structuring of this form, including required fields for both complainant and respondent details, alongside specific instructions for submission, illustrates the Equal Rights Division's commitment to facilitating a transparent, accessible process for those looking to withdraw their complaints.
| Question | Answer |
|---|---|
| Form Name | Form Erd 4971 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | Statutes, MEOC, WI, Workforce |
State of Wisconsin
Department of Workforce Development
Equal Rights Division
Civil Rights Bureau
Request to Withdraw Complaint
NOTICE REQUIRED UNDER Section 15.04(1)(m), Wisconsin Statutes. Authorization for this form is provided under Section 111.375, Wisconsin Statutes. Completion of this form is voluntary. However, if you wish to file a withdrawal of a discrimination complaint with the Equal Rights Division, you must submit a written document containing the information sought by this form. Personal information you provide may be used for secondary purposes.
Complainant |
Respondent |
First Name |
Respondent Name |
Middle Name |
|
Last Name |
|
Street Address |
Street Address |
City |
City |
State |
State |
Zip Code |
Zip Code |
I wish to withdraw my discrimination complaint against the above named respondent(s) filed with the:
Department of Workforce Development Equal Rights Division
(ERD) Case Number
U.S. Equal Employment Opportunity Commission
(EEOC) Case Number
City of Madison Equal Opportunities Commission
(MEOC) Case Number
I have been advised that under state, federal and local laws it is unlawful for any person to threaten intimidate or harass me because I have filed a complaint.
Signature |
Date Signed |
I make this request for the following reason(s):
Send Completed form to:
THE EQUAL RIGHTS DIVISION
201 E WASHINGTON AVE ROOM A300 PO BOX 8928
MADISON WI 53708
THE EQUAL RIGHTS DIVISION 819 N 6TH ST
ROOM 255 MILWAUKEE WI 53203