Century College Office of Diversity and Inclusion Complaint Form 4
Explain your complaint in detail. Add additional pages if necessary and attach documents you believe may be helpful
in investigating your complaint.
1. Describe the specific incident(s) of discrimination/harassment/retaliation. List dates, times, locations, names, and
titles of the people involved in the incident(s).
2. Explain why you believe that you were discriminated/harassed/retaliated against because of your protected class
status e.g., race, age, sex, disability.
3. Provide the names and titles of people you believe were treated more favorably than you due to your protected
class status. If known, list the protected class status, e.g., race, age, sex, disability of each person.
If more space is needed, please attach to this form.