Formal Complaint

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Name *

Date of Incident: *

Where did the specific event occur? *

Please explain the events that occurred? *

Were there any witnesses to this specific event? (If yes, please provide their names) *

Why do you believe you are being discriminated, harassed, or retaliated against, including the reason or evidence you have to support your belief? *

How did you feel? *

What would be your desired outcome as a result of an investigation? *

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