COMPLAINT FORM (Discrimination, Anti-Bullying, and Anti-Harassment)
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Today's Date *
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Name of Complainant:   *
Are you filling out this form for yourself or someone else (please identify the individual if you are submitting on behalf of someone else): *
Who or what entity do you believe discriminated against, harassed, or bullied you (or someone else)? *
Date and place of alleged incident(s): *
Names of any witnesses (if any): *
Nature of discrimination, harassment, or bullying alleged (check all that apply): *
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In the space below, please describe what happened and why you believe that you or someone else has been discriminated against, harassed, or bullied. Please be as specific as possible. *
I agree that all of the information on this form is accurate and true to the best of my knowledge. *
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