Sexual Harassment Complaint Form
* Indicates required field
Name: *
Status:
If employee, administrative unit and position title:
Campus Address:
Campus Phone Number:
Individual engaged in alleged harassment:
Your relationship to the individual engaged in alleged harassment:
Please describe the specific act(s) alleged:
Location of alleged incident:
Date(s) and approximate time(s):
Is there any other person who has witnessed this behavior or other who experienced similar behavior by the individual mentioned above? If so, please provide name(s), indicate if any witness or individual with similar experience, his address(s) and phone number(s).:
Did you take any action(s) in an attempt to stop the harassment?:
Do you have any suggestion for proposed action to address or resolve the harassment?:
Do you have any additional information and comments?:
What kind of action do you expect to be taken, Specify