Fillable Harassment-complaint Alabama Agricultural and Mechanical University

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Harassment-complaint Alabama Agricultural and Mechanical University

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Alabama Agricultural and Mechanical University
Office of Human Resources
Mailing Address: Human Resources, Alabama A&M University, Normal, AL 35762
Phone: 256.372.5835 Fax: 256.372.4881
Complaint Form
(This form is only to be used to file a complaint of discrimination, harassment, and/or retaliation.)
(Print or Type)
Alabama A&M University Complaint Form
Office of Human Resources May 2018
Page 1 of 3
General Information:
Name: Date:
Undergraduate Student Graduate Student Staff Faculty
______ Other: _______________________________________
Current Address:
Home Number: _ Cell Number:
Email address:
Respondent (s)- person(s) against whom the complaint is being filed
Alleged Offender’s Name:
Alleged Offender: Faculty Staff Student Other
Department:
Alleged Offender’s Name:
Alleged Offender: Faculty Staff Student Other
Department:
Basic of Your Complaint-check all that apply
___ Age ___ National/Ethnic Origin
___ Color ___ Political Affiliation
___ Disability ___ Race
___ Religion ___ Sexual Orientation
___ Retaliation ___ Sex (including pregnancy)
___ Veteran Status ___ Other/Not for Sure
Explain: ____________________________________
___ Family Medical and Genetic Information
Alabama Agricultural and Mechanical University
Office of Human Resources
Mailing Address: Human Resources, Alabama A&M University, Normal, AL 35762
Phone: 256.372.5835 Fax: 256.372.4881
Complaint Form
(This form is only to be used to file a complaint of discrimination, harassment, and/or retaliation.)
(Print or Type)
Alabama A&M University Complaint Form
Office of Human Resources May 2018
Page 2 of 3
Explanation of Circumstances
Describe what you believe to be discrimination, harassment, and/or retaliation, include details about any
harm you have suffered. List each incident, including the date, and provide any other details which
support your complaint. Identify all persons involved. If necessary, please attach additional pages.
Witnesses
List everyone you believe can provide relevant information regarding your complaint. Include all contact
information (i.e., name, phone, email address) for each witness as well as a brief explanation of the
witness’s knowledge. If necessary, please attach additional pages.
Alabama Agricultural and Mechanical University
Office of Human Resources
Mailing Address: Human Resources, Alabama A&M University, Normal, AL 35762
Phone: 256.372.5835 Fax: 256.372.4881
Complaint Form
(This form is only to be used to file a complaint of discrimination, harassment, and/or retaliation.)
(Print or Type)
Alabama A&M University Complaint Form
Office of Human Resources May 2018
Page 3 of 3
Evidence
Do you have evidence supporting the incidents described above i.e., letters, emails, photos, etc. (attach
evidence if possible): Yes No Evidence attached
Is there any physical evidence that supports your complaint? If so, please describe or attach a copy.
Acknowledgment
To investigate your complaint, it will be necessary to interview you, the alleged respondent(s), and any
witnesses with knowledge of the allegations or defenses. Complaints and actions taken to resolve
complaints will be handled as confidentially as possible, given the University’s obligations to investigate
and act upon reports of such complaint. Confidentiality will be maintained throughout the investigation
of any complaint to the extent possible, while remaining consistent with the goal of conducting a
thorough investigation and implementing corrective action, as appropriate.
The information provided in this complaint is true and correct to the best of my knowledge. Making false
or frivolous allegations is in violation of the University’s policy. I am willing to cooperate fully in the
investigation of my complaint and provide whatever evidence the University deems relevant.
Signature Date
Please return to the Office of Human Resources
or mail to the address at the top of the form or fax to (256)372-5881.
For questions, please call (256) 372-5835.
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Harassment-complaint Alabama Agricultural and Mechanical University

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Completed 3 November 2019

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