Office of Equity & Diversity

Faculty
Administrative
Classified
Student
Other (specify):

race/color
disability
age
religion/creed
sex
gender identity/gender expression
sexual orientation
sexual harassment
retaliation
national origin
veteran's status
marital status
ancestry
Other (specify):

Complaint Against:

1. Name:

2. Status:

3. Date of most recent action/incident involving you:

4. Specific Allegation: Specify what happened in chronological order to the best of your ability. Please include dates, times, names, and phone numbers of any witnesses or others who can corroborate your allegations: (attach any additional relevant documentation or evidence to support your allegations)

5. What steps, if any, have you taken to date to resolve this complaint? (please indicate names and dates)

6. What do you see as a remedy to your complaint?