OED Complaint Form
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Please check this box if you agree with the following: I request that the Office for Equity and Diversity (OED) 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.
Please identify your relationship with the University (Check One):
Other's with Knowledge of Issue::
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 enter the type of complaint above, check one or more.
Describe your complaint and include relevant dates that the alleged behavior occurred. (Please summarize above.)
When did the behavior begin?::
When was the last time that the behavior occurred?::
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 above.
Relationship with Witness #1:
Witness #1 Phone:
Relationship with Witness #2:
Witness #2 Phone:
Please give us any additional information that we may need.
Check here to certify that all the above information is true and correct.
NOTE: The OED endeavors to respond to complaints within one (1) business day. If you do not receive a response from an OED staff member, please contact us at 252-328-6804. Thank you.
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