SOCIETY MEETING CODE OF CONDUCT COMPLAINT FORM
Full Name *
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Email *
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Phone
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Home Address
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Date/Time of Incident
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Complaint
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Emergency Contact's Name
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Emergency Contact's Email
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Emergency Contact's Phone
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Name of the person you believe harassed you or another person
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If the alleged harassment was toward another person, identify that person
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Describe the incident(s) as clearly as possible. Include a full description of the events, verbal statements (threats, requests, demands, etc.), the location, date, time, and what, if any, physical contact was involved.
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List any witnesses who were present
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How did you or the person harassed (if not you) react to the harassment?
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What contact did you or the person harassed (if not you) have with the alleged harasser before the first incident?
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This complaint is based upon my honest belief that harassment has occurred against me or another person. I certify that the information I have provided in this complaint is true, correct and complete to the best of my knowledge. *
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