Equity and Inclusion Complaint Form

Status of Complainant:
Faculty
Staff
Student
Other
If Complainant is an employee:
If Complainant is a student:
Student Status:
Type of Complaint:
Discrimination
Harassment
Basis of Complaint:
Age
Color
Disability
Gender Identity
Marital Status
Military Service
National Origin
Parental Status
Pregnancy
Race
Religion
Retaliation
Sex/Gender
Sexual Assault
Sexual Harassment
Sexual Orientation
Sexual Violence
Veteran Status
Status of Respondent(s):
Faculty
Staff
Student
Other
Relationship of Respondent(s) to Complainant:
Co-Worker
Client/Customer
Faculty
Subordinate
Supervisor
Student
Other
Did you take any action to stop the alleged behavior?
I am aware that an informal process is available to resolve the complaint, and feel that a formal complaint is appropriate to resolve the discrimination and harassment I allege in this complaint. I understand that I may have rights to relief under state and federal laws, and that complaints of discrimination may be filed with state and federal civil rights agencies.

I certify that to the best of my knowledge, the information that I provided is accurate and the events and circumstances are as I have described them. I understand that a copy of this complaint will be provided to the respondent. I agree to cooperate with any investigation conducted by the University into this matter and provide whatever evidence the University deems relevant. While complete confidentiality cannot be guaranteed, I understand that all complaints will be handled in such a way that confidentiality will be protected to the fullest extent possible.

I understand that if I am found to have knowingly misstated any material fact in this complaint I may be subject to discipline in accordance with applicable University policies and procedures for students and employees.