Fillable Get File Group Id 4202574 (California Maritime Academy)

Fill Online, Printable, Fillable, Blank Get File Group Id 4202574 (California Maritime Academy) Form

Use Fill to complete blank online CALIFORNIA MARITIME ACADEMY pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Get File Group Id 4202574 (California Maritime Academy)

On average this form takes 18 minutes to complete

The Get File Group Id 4202574 (California Maritime Academy) form is 3 pages long and contains:

  • 1 signature
  • 27 check-boxes
  • 57 other fields

Country of origin: US
File type: PDF

U.S.A. forms for California Maritime Academy

BROWSE CALIFORNIA MARITIME ACADEMY FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Executive Order 1097
Revised March 29, 2019
Attachment A
STUDENT COMPLAINT
FORM
Executive Order 1097 provides students a systemwide procedure to file complaints alleging violations of the California State University
(CSU) systemwide policy prohibiting Discrimination, Harassment, Retaliation, Sexual Misconduct, Dating or Domestic Violence or
Stalking against students by the CSU, Employees, other Students, or Third Parties. Please fill in all of the information requested
below as completely as possible and attach additional pages to this form, if necessary.
CSU Campus
Work Phone
Last Name First Name MI
Mailing
Address
City
Cell Phone
Home Phone
Best time to call: AM/PM
State Zip Code
E-mail
Currently a CSU Student? Yes
No
Last CSU Registration Date
Currently a CSU Applicant? Yes
No
Last CSU Application Date
Was Early Resolution sought?
Yes
No
If yes, with whom: Date
Indicate the type(s) of complaint being filed:
Discrimination
Harassment Retaliation
Sexual Misconduct Dating Violence Domestic Violence Stalking
If you are filing a Discrimination or Harassment complaint, indicate the protected status(es) that was/were the basis(es) of the alleged
Discrimination or Harassment. (Please select all that apply):
Race/Color
National Origin/Ancestry
Marital Status
Religion
Gender/Sex
Gender Identity/Expression
Sexual Orientation
Disability
Military/Veteran Status
Medical Condition
Genetic Information
Age
If you are filing a Retaliation complaint, indicate the activity(ies) you engaged in that was/were the basis(es) for the alleged Retaliation.
.
Page 1 of 3
STUDENT COMPLAINT FORM
1. Identify the Respondent(s) against whom your complaint is made. For each Respondent, provide the identifying information
requested below. Attach additional pages to this form if necessary.
Respondent(s) name:
Relationship/Association with the campus:
Relationship/Association to you:
2. Describe the incident(s) or event(s), date(s), time(s), and location(s) giving rise to your complaint.
Attach additional pages to this form, if necessary.
3. Describe the specific harm you have suffered resulting from the incident(s). Attach additional pages to this form, if necessary.
4. What did you or others do to try to resolve the complaint? What was the outcome?
Page 2 of 3
Executive Order 1097
Revised March 29, 2019
Attachment A
STUDENT COMPLAINT FORM
5.
Identify
individuals
who
may
have
observed
or
witnessed
the
incident(s)
that
you
described.
Last Name First Name MI
Telephone
Position/
Job Title
E-mail
Last
Name First Name MI
Position/
Job Title
E-mail
Cell Phone
Telephone
Cell Phone
6. Do you have any documents or electronic communications (including text messages or email) that support your complaint?
Yes
No
(Please list and attach a copy.)
7. Do you have any physical evidence (such as photographs, videos, blood tests or rape kits) that support your complaint? (Please describe)
8. Describe the outcome(s) you expect from filing your complaint. Be as specific as possible.
You may elect to have an Advisor present at meeting(s) and/or interview(s) which may be a Sexual Assault Victim’s Advocate. If you
indicate you will have an Advisor, you are authorizing that individual to accompany you to any meeting(s) and/or interview(s) regarding
this complaint. The role of the Advisor is limited to observing and consulting with you.
9. If you will be accompanied by an Advisor, provide the name and telephone number.
Last Name
First Name
MI
Telephone
CERTIFICATION
Cell Phone
I certify that the information given in this complaint is true and correct to the best of my knowledge or belief.
Print Name of Student
Signature of Student
Date
For
University
Use
Only:
Date
Complaint
Received
Signature
Page 3 of 3
Executive Order 1097
Revised March 29, 2019
Attachment A
click to sign
signature
click to edit
Executive Order 1097
Revised March 29, 2019
Attachment B
CSU Student Complaint Procedure Timeline
Page 1 of 2
Pursuant to Executive Order (EO) 1097, a “Student”, defined as an applicant for admission to the CSU,
an admitted CSU Student, an enrolled CSU Student, a CSU extended education Student, a CSU Student
between academic terms, a CSU graduate awaiting a degree, a CSU Student currently serving a
suspension or interim suspension, and a CSU Student who withdraws from the University while a
disciplinary matter (including investigation) is pending, may file a Complaint related to Discrimination,
Harassment, Retaliation, Sexual Misconduct, Dating or Domestic Violence or Stalking.
Immediately following an act/action/incident that falls under Executive Order 1097 or as soon
as possible thereafter, Students who believe they are or may have been victims of Discrimination,
Harassment, Retaliation, Sexual Misconduct, Dating or Domestic Violence or Stalking, may initiate
the Article III. Campus Procedure for Responding to Complaints to receive information about
the procedures that exist for resolving such matters. All incidents should be reported even if a
significant amount of time has passed. However, delaying a report or Complaint may impede the
ability to conduct an investigation or take appropriate remedial actions.
For the purpose of this Executive Order, Working Days are defined as Monday through Friday,
excluding all official holidays or Campus closures at the Campus where the Complaint originated or at
the Chancellor’s Office (CO) where the Complaint Appeal is reviewed.
Within ten (10) Working Days after receipt of a Complaint, an intake interview shall be
conducted with the Complainant.
Within ten (10) Working Days after reviewing all written Complaints and the information received
during the intake interview, the Discrimination/Harassment/Retaliation (DHR) Administrator or
Title IX Coordinator will notify the Complainant that the Complaint has been accepted for
investigation and the timeline for completion of the investigation. If the DHR Administrator or Title
IX Coordinator determines the Complainant has failed to state a Complaint within the scope of this
Executive Order, s/he will provide the Complainant with written notice of this determination within
ten (10) Working Days. The DHR Administrator or Title IX Coordinator will also inform the
Complainant that if additional information is provided, the Complaint will be reviewed again.
Within sixty (60) Working Days after the intake interview, the Investigator shall complete the
investigation, write and submit an investigation report to the campus designated DHR Administrator
or Title IX Coordinator. If this timeline is extended pursuant to Article V. E, it shall not be extended
for a period longer than an additional thirty (30) Working Days from the original due date.
Within ten (10) Working Days of receiving the investigation report, the DHR Administrator or
Title IX Coordinator shall review the investigation report and notify the Parties in writing of the
investigation outcome. If the DHR Administrator or Title IX Coordinator performed the
investigation, s/he shall notify the Parties in writing of the investigation outcome within ten (10)
Working Days of completing the investigation report. The Notice shall indicate whether or not this
Executive Order was violated and the Complainant’s and Respondent’s right to file an Appeal under
this policy.
Executive Order 1097
Revised March 29, 2019
Attachment B
CSU Student Complaint Procedure Timeline
Page 2 of 2
Within ten (10) Working Days after the date of the Notice of Investigation Outcome, the
Student may file a written Appeal with the CO.
Within thirty (30) Working Days after receipt of the written Appeal, the CO designee shall
respond to the appealing party, unless the timeline has been extended pursuant to Article IV. G. or
Article V. E. A separate notification shall be provided to the non-appealing party, indicating
whether or not the allegations were substantiated on Appeal by a Preponderance of the Evidence.
Closure. The CO Appeal Response is final and concludes the Complaint and Appeal process under
this Executive Order.
Pursuant to EO 1097 Article V. E, the timelines noted above may be extended as follows:
The timeline for the procedures contained within this Executive Order may be extended for
any reason deemed to be legitimate by the Campus investigator/CO Appeal reviewer or
by mutual agreement of the Parties. The timelines stated within this Executive Order will
be automatically adjusted for a reasonable time
period that should not exceed an additional
thirty (30) Working Days for a Campus investigation or an additional thirty (30) Working
Days for a reopened Campus investigation under Article IV. The Complainant and Respondent
shall receive written notification of any period of extension.
***Note that for matters that fall under the scope of the 2019 Addendum, these timelines are not
applicable. Please contact your campus Title IX Coordinator for additional guidance.
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Get File Group Id 4202574 (California Maritime Academy)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 19 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document