Discrimination and Harassment

Discrimination and Harassment Reporting Form

 

Enter your first and last name.

Address*

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Enter your local address.

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Enter your preferred phone number.

Please select date of incident.

Please list time incident occurred.

Please name and describe the location of the incident.

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

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

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

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.

Please select today's date to align with your signature.