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Nondiscrimination/Equal Opportunity(Complaint Form): AC-E-2

  • Foundations Commitment: A
Nondiscrimination/Equal Opportunity(Complaint Form): AC-E-2

Date:__________________________________________

Name of complainant:_____________________________

School:_________________________________________

Address:________________________________________

Phone:_________________________________________

Summary of alleged unlawful discrimination or harassment:

Name(s) of individual(s) allegedly engaging in prohibited conduct:

Date(s) alleged prohibited conduct occurred:

Name(s) of witness(es) to alleged prohibited conduct:

If others are affected by the possible unlawful discrimination or harassment, please give their names:

Your suggestions regarding resolving the complaint

Please describe any corrective action you wish to see taken with regard to the alleged unlawful discrimination or harassment. You may also provide other information relevant to this complaint.

Signature of complainant _______________________________

Date________________________

Signature of person receiving complaint____________________ 

Date________________________

Revised: August 15, 2020