Discrimination/Harassment Complaint Form |
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This form is designed to assist you with filing a discrimination and/or harassment complaint. Please write clearly and focus on the alleged discriminatory and/or harassing conduct. The complaint should include as much information regarding the incident giving rise to the complaint as possible, including the location, date and time of the alleged incident(s); the name of the individual or group whom the complaint is against, if known; a description of the incident(s); and the remedy sought. |
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Name of person filing the complaint: _____ | Date: _____ |
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Signature: _____ | Date: _____ |
You may use the back side of this sheet if needed. Please return this form to the Title IX/EEO coordinator, LDC 235. |
[Statutory Authority: Chapter
28B.50 RCW. WSR 18-17-025, § 132U-300-140, filed 8/6/18, effective 9/6/18.]