Please complete the following information as thoroughly as possible. Required
fields are denoted by an asterisk. (*)
Nature of Complaint:
If other, please explain.
Person Whom you are Reporting Violated Title IX
Description of Complaint: Describe your complaint and why you believe
this person discriminated /retaliated against you. Explain why you have contact
with this person (e.g. supervisor, co-worker, faculty, customer, etc). Give date(s),
time(s), and place(s) the discrimination/retaliation occured. (Attach additional
pages as necessary.)
Previous Action: Have you brough this matter to the attention of
any other department(s) at the university? If so, please list the name(s) and department(s)
of all other persons with whom you have disscussed this matter.
Complaint Documentation: Explain any documentation supporting your
Corrective Action Sought: (Attach additional pages as necessary.)
Witnesses:(Relationship= co-worker, supervisor, customer, faculty,