Directory

Unlawful Discrimination
Unlawful Discrimination based on: Race Color Religion Ethnicity Gender Age National Origin Disability Veteran's Status Retaliation
Complainant's Background Information
Complainant Name:	* required	Employee Student
Home Address:				E-mail:	* required Valid email address.
Campus Phone #:		Home Phone #:		Cell #:
If an Employee: Position/Title:		Department/Office & Location:
Bargaining Unit:		Work Ext.#:
Supervisor's Name:		Supervisor's Position/Title:
If a Student:	Freshman Sophomore Junior Senior Graduate
Major:
Advisor's Name:		Advisor's Position/Title:
Respondent's Background Information (List as much information as known)
Respondent's Name:	* required	E-mail:	* required Valid email address.
If an Employee: Position/Title:	* required	Department/Office & Location
Bargaining Unit:		Work Ext.#:
Respondent's Supervisor:		Supervisor's Position/Title:
If a Student:	Freshman Sophomore Junior Senior Graduate			Major:
Contact Information:
Complaint Allegations
Explain the nature of your complaint: (include WHEN and WHERE it occurred)	* required
Are there any documents in your possession related to the allegations of the complaint?					Yes No
Witness Information
Witness #1 - Name & Contact Information:
Summary:
Witness #2 - Name & Contact Information:
Summary:
Witness #3 - Name & Contact Information:
Summary:
Supplemental Information