REPORTING FORM FOR COMPLAINTS OF …

REPORTING form FOR COMPLAINTS OF discrimination OR harrassment Complainant: _____ Are you a student: _____ parent: _____ visitor: _____ employee: _____ other: _____ Home Address: _____ Work Address: _____ Home Phone: _____ Work Phone: _____ Did the incidence involve: gender _____ race/color _____ national origin _____ disability _____ age _____ religion _____ Name of person you believe discriminated against or harassed you or another person: _____ If the alleged discrimination or harassment was toward another person, identify that other person (including address or location): _____ Describe the incident as clearly as possible in your own words, including such things as what force, if any, was used, any verbal statements ( , threats, requests, demands, etc.)

REPORTING FORM FOR COMPLAINTS OF DISCRIMINATION OR HARRASSMENT Complainant: _____ Are you a student: _____ parent: _____ visitor: _____ employee: _____ other: _____

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  Form, Discrimination, Complaints, Form for complaints of, Form for complaints of discrimination or harrassment, Harrassment

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