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Student 1
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HUMAN RESOURCES

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Discrimination/Harassment/Sexual Misconduct Complaint Form

 
PNumber: (required)
(Look-up your PNumber.)

(Please make sure the "P" is capitlized.)
First Name: (required)
Last Name: (required)
Street Address 1: (required)
Street Address (cont.):
City: (required)
State: (required)
Zipcode: (required)
E-mail: (required)
Home Phone Number: (required) - -
Cell Phone Number: - -
Work Phone Number: - -
 
Name(s) of person(s) accused of wrongdoing: (required)

Describe all actions of person(s) named above. Be as detailed as possible: include the date, time, and place of each event(s) or conduct involved. (required)

Names of witnesses to the above-described events (including phone number, if known):

Names of anyone with whom you discussed the above-described events (including phone number, if known):

How would you like this matter resolved? (required)