Harassment Complaint Form
Completed forms are automatically sent to Rebecca Zimmerman, Chief of Staff.
* Required
COMPLAINANT INFORMATION
About the person issuing the complaint
Name
*
Your answer
HKC Site
*
Long Island
Pearl River
Staten Island
Job Title
*
Your answer
Email Address
*
Your answer
Phone Number
*
Your answer
Preferred Communication Method
*
Email
Phone
In Person
SUPERVISOR INFORMATION
Supervisor's Name
*
Your answer
Supervisor's Title
*
Your answer
Supervisor's Email Address
*
Your answer
Supervisor's Work Phone
*
Your answer
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