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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.
Name: *
Your answer
Email Address: *
Your answer
Phone #: *
Your answer
What is the best way to contact you? *
Please tell us why you are filing a grievance: *
Your answer
When did the problem initially occur? If it's been an ongoing issue, you can enter multiple dates: *
Your answer
Have you engaged in dialogue with the person(s) against whom you are filing this grievance prior to filling out this form? *
Please let us know of any other individuals who may be involved or have additional information that we should take into account: *
Your answer
Are you open to mediation with the person(s) against whom you are filing this grievance? *
If you answered "maybe" to the above question, please explain your concerns here:
Your answer
What is your desired outcome? *
Your answer
Is there anything else we should know?
Your answer
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