Human Resources Office
SEXUAL HARASSMENT COMPLAINT
Page 1 of 3; Sexual Harassment Complaint Created: 9/8/2016; Rev: 10/13/2017
TMCC is an EEO/AA institution. See http://eeo.tmcc.edu for more information.
In accordance with the NSHE Board of Regents Handbook, Title 4, Chapter 8, Section 13, sexual harassment does
not refer to occasional compliments of a socially acceptable nature. It refers to behavior of a sexual nature that is not
welcome, that is personally offensive, and that interferes with performance. Complaints of sexual harassment are taken
very seriously and will be dealt with promptly, thoroughly, impartially, and equitably.
This completed form should be filed with one of the following individuals or any person in a supervisory, managerial,
administrative or executive role or position at TMCC so that the allegations may be investigated.
Veronica Fox
Director, Human Resources
7000 Dandini Blvd., Library 203A
Reno, NV 89512
Email: vfox@tmcc.edu
Kim Studebaker
Assistant Director, Human Resources
7000 Dandini Blvd., Library 203B
Reno, NV 89512
Email: kstudebaker@tmcc.edu
Please feel free to add additional sheets to explain your concerns to us as necessary. Keep a copy of this form for your
records.
PERSONAL INFORMATION
Last Name
First Name
MI
TMCC Student or Employee ID
Date
Mailing Address
City
State
Daytime Telephone
Evening Telephone
Email
Additional Information
Are you a TMCC employee?
Yes No
TMCC Department
Your Title
Name of Supervisor
Title of Supervisor
Supervisor's Telephone Number
Instructions
Reset
Print
Sexual Harassment Complaint
Page 2 of 3; Sexual Harassment Complaint Rev.: 10/13/2017
TMCC is an EEO/AA institution. See http://eeo.tmcc.edu for more information.
DETAILS OF INCIDENT(S)
Please identify the person(s) who was responsible for the sexual harassment incident(s)
Name Role or Position at TMCC Relationship
Please describe the sexual harassment incident(s), providing as many specific details as possible, including date(s), time(s), location(s) of
occurrence(s), and any individuals who may have directly witnessed the occurrence(s)
Have you reported this/these incidents to anyone else at TMCC? Yes No
If you have reported this/these incidents to anyone else at TMCC, please identify to whom you reported the incidents and when
Name Role or Position at TMCC Date Notified of Incidents
Sexual Harassment Complaint
Page 3 of 3; Sexual Harassment Complaint Rev.: 10/13/2017
TMCC is an EEO/AA institution. See http://eeo.tmcc.edu for more information.
BY MY SIGNATURE BELOW
I understand that in order for TMCC to investigate the allegations in my complaint, it will likely be necessary for TMCC to
reveal my identity to the person(s) alleged to have sexually harassed me and to disclose information about my complaint
to such person(s), including the details I have provided as part of my complaint.
I understand that the investigating person at TMCC may disclose information about my complaint, including personally
identifying details, to other TMCC officials who have a need to know this information.
I understand that as a complainant, I may not be intimidated or retaliated against for having filed a complaint of sexual
harassment.
I acknowledge that the information I have provided in this complaint is complete, true and accurate to the best of my
knowledge.
I further acknowledge that I have read, understood, and agree to the above information and I authorize TMCC to conduct
an investigation into the allegations in my complaint, and that I am filing this complaint voluntarily.
_____________________________________________________________________________ ____________________________________________
Signature Date
For Official Use Only
File Number: _____________________
Completed Form Received by:
Name: ____________________________________________ Title: _________________________________________
Department: ______________________________________________________ Date: __________________________
Complaint form forwarded to Primary Officer:
Received By: ______________________________________________________ Date: __________________________
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