AA Complaint Form

 

I. PERSONAL INFORMATION:

 

II. RELATIONSHIP TO NAU:

 

 

III. EMPLOYEE/STUDENT INFORMATION:

 

IV. PERSON(S) YOU BELIEVE ARE DISCRIMINATING AGAINST YOU OR HARASSING YOU:

 

 

 

 

 

 

 

V. PERSONS YOU BELIEVE MAY HAVE KNOWLEDGE OF THE DISCRIMINATORY OR HARASSING TREATMENT YOU RECEIVED:

 

 

 

 

 

 

VI. TYPE OF COMPLAINT:On what basis do you believe you were discriminated against or harassed?

Check all that apply: 

 
 
 
 
 

 

VII. BRIEFLY DESCRIBE HOW YOU BELIEVE YOU WERE DISCRIMINATED AGAINST OR HARASSED: (For each incident provide: date, location and names of persons involved)

 

 

 

 

 

 

 

VIII. ACTIONS YOU HAVE TAKEN TO DATE:

 

 

 

 

 

 

 

 

 

 

 

IX. WHAT WOULD YOU CONSIDER APPROPRIATE RESOLUTION TO YOUR COMPLAINT? (Please address below)

By checking the box below, I understand that this complaint will be forwarded to the Northern Arizona University Office of Affirmative Action and Equal Opportunity in accordance with the Safe Working and Learning Environment Policy.

I understand that the Office of Affirmative Action and Equal Opportunity cannot promise confidentiality. I will discuss any particular concerns I have regarding confidentiality with the assigned investigator.

I understand that under state and federal law, as well as Northern Arizona University Policy, I may not be retaliated against with respect to my prospective or current employment or academic status for filing a charge of discrimination or harassment based upon a protected category, participating in an investigation or opposing a discriminatory practice which violated applicable law or university policy.

I understand that, under Northern Arizona University Policy, if the results of an investigation show that a complainant knowingly filed false accusations of discrimination or harassment, such individuals will be subject to appropriate disciplinary action.

I affirm that I have read the above acknowledgment and affirm that the information I have provided in this complaint and attachments is true and accurate to the best of my knowledge.