Anti-Discrimination Form - State Of New York

INTERN SUPERVISOR FILLS OUT THIS FORM.

Student returns this form to Liberal Studies Office.

ANTI-DISCRIMINATION FORM

____________________________________ Agrees to observe all Federal, State, and

(Print Company Name)

Local laws, and New York University policy prohibiting illegal discrimination on the bases of race, color,

religion, national origin, age, sex, sexual orientation, handicap or disability, disabled veteran or veteran of

the Vietnam era, status, including but not limited to all aspects of employment or education.

____________________________________ Acknowledges receipt of a copy of the

(Print Company Name)

New York University’s written policies prohibiting such discrimination.

Supervisor’s Name:

___________________________________

Supervisor’s Signature:

____________________________________

Date:

____________________________________

Return completed forms to 726 Broadway, 6th Floor, New York, NY 10003 or FAX to: (212) 995-4137

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Parent category: Legal