DISCRIMINATION/HARASSMENT
COMPLAINT FORM
FOR COMPLAINTS AGAINST A STUDENT:
Instructions: Submit this form to the Title IX Coordinator, Midlands Technical College, PO Box 2408, Columbia, SC, 29202; or
hand-deliver to the Title IX Coordinator, Saluda Hall, Oce of Business Aairs, Airport Campus, 1260 Lexington Drive, West
Columbia, SC 29170. If a faculty or sta member is made aware of an allegation in which the accused is a student, he/she
must notify the Title IX Coordinator. Filing an allegation of discrimination or harassment with the college does not preclude a
complainant from filing an allegation with an external agency nor does it extend time limits for such complaints.
FOR COMPLAINTS AGAINST AN EMPLOYEE:
Instructions: Submit this form to the Human Resources Department (mail to Midlands Technical College, HRM, PO Box 2408,
Columbia, SC 29202; or hand-deliver to Reed Hall, Room 134, 1260 Lexington Drive, West Columbia, SC 29170).
Person alleging discrimination/harassment or person referring the complaint:
Name: .....Student ID (if applicable):
Department: .....Email Address:
Contact Address:
Phone number (Daytime): ....(Evening):
MTC Status: o Faculty/Sta o Student o Other (please specify)
Person who is accused of discrimination/harassment:
Name: .....Title:
Department: .....Email Address:
Contact Address:
Phone Number (Daytime): ....(Evening):
MTC Status: o Faculty/Sta o Student o Other (please specify)
Describe specific act(s) alleged with name(s), date(s), time(s) and location(s) if possible. If additional space is needed, use reverse
side of paper or attach additional sheets.
Basis of Discrimination/Harassment: o Race/Color o Age o Sexual Misconduct o Gender o National Origin/Creed/Ancestry
o Disability o Sexual Orientation o Genetic Information o Pregnancy o Religion o Retaliation o Military Service
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midlandstech.edu
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PO Box 2408
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Columbia, SC 29202
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803.822.3263
