The Equity and Access Office 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 Equity and Access Office in accordance with the Safe Working and Learning Environment Policy.

I understand that the Equity and Access Office cannot promise confidentiality. I will discuss any particular concerns I have regarding confidentiality with the assigned investigator.