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DSA San Diego Official Harassment Grievance Form
Completion of this form helps ensure thorough investigation + resolution of harassment grievances within our chapter.
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Name:
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Your answer
Email Address:
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Your answer
Phone #:
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Your answer
What is the best way to contact you?
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Phone
Email
No Preference
Other:
Please tell us why you are filing a grievance:
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Your answer
When did the problem initially occur? If it's been an ongoing issue, you can enter multiple dates:
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Your answer
Have you engaged in dialogue with the person(s) against whom you are filing this grievance prior to filling out this form?
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Yes
No
Please let us know of any other individuals who may be involved or have additional information that we should take into account:
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Your answer
Are you open to mediation with the person(s) against whom you are filing this grievance?
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Yes
No
Maybe
If you answered "maybe" to the above question, please explain your concerns here:
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What is your desired outcome?
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Your answer
Is there anything else we should know?
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