9010.2-E.1

SEXUAL HARASSMENT FORMAL COMPLAINT FORM

Name and position of complainant: ______________________________________

Date of complaint: __________________________________________________

Name of alleged sexual harasser: ________________________________________

Date and place of incident: _____________________________________________

__________________________________________________________________

Description of misconduct: _____________________________________________

__________________________________________________________________

__________________________________________________________________

Name of witnesses (if any): ____________________________________________

__________________________________________________________________

__________________________________________________________________

Has the incident been reported before? ___________________________________

If yes, when?_______________________ _________________________________

To whom?_________________________________________________________

What was the resolution? ______________________________________________

__________________________________________________________________

Reasons for dissatisfaction: ____________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

9010.2-E.2

SEXUAL HARASSMENT COMPLAINT - APPEAL FORM

Name and position of complainant: ______________________________________

Date of appeal:______________________________________________________

Date of original complaint: _____________________________________________

Have there been any prior appeals? ______________________________________

If yes, when?_______________________________________________________

To whom?_________________________________________________________

Description of decision being appealed: ___________________________________

__________________________________________________________________

__________________________________________________________________

Why is the decision being appealed? _____________________________________

__________________________________________________________________

__________________________________________________________________

Adoption date: January 1, 1993

Reviewed on:    April 8, 2003