Revised November 2016
INFORMAL Complaint Form
This form is to be completed if you wish to make an INFORMAL complaint pursuant to Regent College’s
Bullying, Harassment and Discrimination Prevention Policy:
Your Name ___________________________________________________________________________
Your association with Regent College_______________________________________________________
(i.e. Student, faculty, staff)
The person(s) against whom you are bringing this informal complaint (the Respondent) ______________
The Respondent’s association with Regent College ____________________________________________
Date of the last incident about which you are reporting ________________________________________
WHAT HAPPENED? Provide details of the behavior you believe constitutes bullying, harassment or
discrimination against you. (Use additional paper if necessary).
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
WHERE AND WHEN DID IT HAPPEN? Please provide all context you consider relevant to a consideration
of whether the behavior reported occurred in the context of a College-related activity:
_____________________________________________________________________________________
_____________________________________________________________________________________
HOW DO YOU HOPE THIS COMPLAINT CAN BE RESOLVED?
_____________________________________________________________________________________
_____________________________________________________________________________________
Date: ______________________ Signature: ___________________________________________
Your contact information (this information will NOT be provided to the Respondent):
Address: __________________telephone: __________________ email: __________________________
Please return this form in a sealed envelope to the Reception desk at Regent College, marked “Harassment
Prevention Officer” or mail to: Harassment Prevention Officer, Regent College, 5800 University Boulevard,
Vancouver, BC V6T 2E4
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