Discrimination Complaint Form

Departments

Code No. 102-E(4)

Discrimination Complaint Form

Discrimination Complaint Form Code No. 102-E(4)

MM slash DD slash YYYY
Name of Complainant:(Required)
Are you filling out this form for yourself or someone else? (please identify the individual if you are submitting on behalf of someone else)(Required)
Submitting on Behalf of:
Leave this field Blank if Submitting for Yourself.
MM slash DD slash YYYY
Nature of discrimination, harassment, or bullying alleged (check all that apply):(Required)
Max. file size: 63 MB.
Acknowlegement of Accuracy(Required)