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Grievance Form

This form, once completed, will be submitted directly to the Office for Equity and Diversity (OED).

The Office for Equity and Diversity will follow up directly with you to confirm receipt of your grievance reporting form within five (5) working days of receipt of a completed grievance form.

Please provide the following information about you (the person filing the complaint) to include your contact information, relationship to the University, etc.

 
  mm/dd/yy
Faculty    
Staff    
Student    
Employment Applicant    
Other    
Have you brought this matter to the attention of any other department(s) at the University? If so, please list the name(s) and department(s) of all other persons with whom you have discussed this matter.

Please provide the following information about your complaint:



Please check this box if you agree with the following: I request that the OED Office does not investigate the issues that I have reported. Please treat as an inquiry only and keep on record for future reference. I understand that depending on the seriousness of the behavior, the OED Office may be required to investigate this issue. If the OED determines it necessary to conduct an investigation, the person who filed the complaint will be initially notified. I understand that the OED Office reserves the right to contact and follow up with the Dept. of Human Resources or Dean of Students regardless of this request.

Age    
Color    
Creed    
Disability    
Genetic Information    
National Origin    
Political Affiliation    
Race/Ethnicity    
Religion    
Retaliation    
Sex/Gender    
Sexual Harassment    
Sexual Orientation    
Veteran Status    
Please enter the type of complaint, check one or more.
Describe your complaint and include relevant dates that the alleged behavior occurred. (Please summarize above.)

  mm/dd/yy
  mm/dd/yy
If the behavior is ongoing, check the box below.

Name of person or persons you believed discriminated against you and why you have contact with them (i.e.. Supervisor, co-worker, faculty, customer)

Describe the corrective action you are seeking. (Please summarize above.)

Please give us any additional information that we may need.

Check here to certify that all the above information is true and correct.

Bolded Fields Required*