Discrimination/harassment Complaint Form Page 4
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5L
P
W
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IST
OTENTIAL
ITNESSES YOU BELIEVE POSSESS INFORMATION ABOUT YOUR COMPLAINT
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DD ADDITIONAL PAGES IF NECESSARY
Name of Witness #1:
(If more than one respondent, list complete information for each)
Address (local):
Address (residence):
City:
State:
Zip:
Home phone _______________ Work phone __________________
Work hours______________
What information can this witness provide?
Name of Witness #2:
(If more than one respondent, list complete information for each)
Address (local):
Address (residence):
City:
State:
Zip:
Home phone _______________ Work phone __________________
Work hours______________
What information can this witness provide?
Name of Witness #3:
(If more than one respondent, list complete information for each)
Address (local):
Address (residence):
City:
State:
Zip:
Home phone _______________ Work phone __________________
Work hours _____________
What information can this witness provide?
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