Discrimination and Harassment Form

Thaddeus Stevens College of Technology does not discriminate in its educational programs or employment practices based on race, color, national origin, sex, sexual orientation, gender identity, disability, age, religion, ancestry, veteran status, or any other legally protected classification.

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Date of incident(Required)

Time of incident(Required)

Location of incident(Required)

(Please name and describe the location of the incident)

Individuals involved(Required)

(Identify the name(s) of the individual(s) against whom you are submitting this complaint)

Description(Required)

(Please describe the nature of the incident, providing as much detail as possible to assist with the investigation of this complaint)

Names and Contacts of witnesses(Required)

(Please provide the names and contact information of any witness(es))

Acknowledgment(Required)

Acknowledgment: By signing this form I understand that this complaint will be investigated, and the alleged harasser(s), any witnesses, and persons of interest will be interviewed. The information provided in this Sexual Harassment Reporting Form is true and accurate to the best of my knowledge. Please type your name as evidence of signature.

Today's Date(Required)

This field is for validation purposes and should be left unchanged.