Complaint Form For Discrimination/harassment/retaliation Complaints Page 2
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3COMPLAINT FORM FOR
Executive Order 1089
Attachment No. 1
DISCRIMINATION/HARASSMENT/RETALIATION COMPLAINTS
1. Identify the Accused against whom your complaint is made. For each Accused, provide the identifying information requested below.
Relationship/Association to you:
Accused's name:
Relationship/Association with the campus:
2. Describe the incident(s) or events(s), date(s), time(s), and location(s) giving rise to your complaint.
3. If you are filing a Harassment complaint, please explain why this conduct was offensive to you.
4. Describe the specific harm you have suffered resulting from the incident(s).
5. What did you or others do to try to resolve the issue? What was the outcome?
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