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Sexual Harassment/Discrimination Form

Please complete the form below. Required fields marked with an asterisk *

Name *

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Job Title*

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Work Address

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Work Phone*

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Email*

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Your complaint of Sexual Harassment is made about:*

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Please describe what happened and how it is affecting you and your work. Please send any relevant documents or evidence to [email protected]*

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Date(s) sexual harassment occurred:*

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Please list the name and contact information of any witnesses or individuals who may have information related to your complaint:

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Optional: Have you previously complained or provided information verbal or written about related incidents? If yes, when and to whom did you complain or provide information?

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If you have retained legal counsel and would like us to work with them, please provide their contact information

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Confirmation Email

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