Office of Institutional Diversity & Equity > About > Forms > Complaint Allegation Form

Discrimination, Harassment, Sexual Harassment and/or Retaliation Complaint Form

























Select a date from the calendar.

Please complete as much information as possible to allow for a prompt response.

SECTION I

Complainant's Information - Please complete this section if you are the individual who is alleging discrimination, harassment, sexual harassment and/or retaliation.

Reporter's Information - Please complete this section if you are required to report a complaint that was presented to you, or if you are reporting an allegation that you observed that involves discrimination, harassment, sexual harassment and/or retaliation.

SECTION II - Respondent's Information

Respondent's Information - This is the individual that the allegation identifies as the person engaging in discrimination, harassment, sexual harassment and/or retaliation.


If more than Two Respondents, please describe below in Section III.

SECTION III - Allegations

Please provide as much information as possible, and be detailed in the area where you explain the specific allegations.

By signing this form I certify that this information is true and correct to the best of my knowledge.

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