Harassment Complaint Form

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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