Fillable Hazing Complaint Form Graduate (City of Oakland)

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Hazing Complaint Form Graduate (City of Oakland)

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BROWSE CITY OF OAKLAND (CA) FORMS

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Section VII Appendix C
Hazing Complaint Form (will be kept confidential)
Name _________________________________________________________________________________
Address________________________________________________________________________________
City / State / ZIP_________________________________________________________________________
Telephone (_______) ________________ Email ______________________________________________
Date of Alleged Hazing Incident_______________________
Place of Alleged Hazing Incident (please provide specifics) _______________________________________
_______________________________________________________________________________________
Specific details of the Alleged Hazing Incident
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
List requested information below of those who allegedly committed the acts complained about:
Name ________________________________________________________________________________
Address_______________________________________________________________________________
City / State / ZIP________________________________________________________________________
Telephone (______) _______________ Email _____________________________________________
Name ________________________________________________________________________________
Address_______________________________________________________________________________
City / State / ZIP________________________________________________________________________
Telephone (______) _______________ Email _____________________________________________
Name ________________________________________________________________________________
Address_______________________________________________________________________________
City / State / ZIP________________________________________________________________________
_
Telephone (______) _______________ Email ______________________________________________
Please use back of form to supply additional information
____________________________________________ _____________
Signature Date
UPON COMPLETION OF THIS FORM, FORWARD IMMEDIATELY TO THE REGIONAL DIRECTOR
VII - 3
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Hazing Complaint Form Graduate (City of Oakland)

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Completed 22 May 2022

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