Fillable Sexual Harassment Formal Complaint Form (White Earth Tribal and Community College)

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Sexual Harassment Formal Complaint Form (White Earth Tribal and Community College)

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The Sexual Harassment Formal Complaint Form (White Earth Tribal and Community College) form is 1 page long and contains:

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  • 16 other fields

Country of origin: US
File type: PDF

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White Earth Tribal and Community College
Sexual Harassment Formal Complaint Form
Submit Completed Form To:
Jessica Asher Phillips WETCC Title IX Coordinator
2250 College Rd, Mahnomen, MN 56557 - Administration, Office #218
Email: Jessica.ap@wetcc.edu Phone: 218-218-936-8338
Complainant’s Name _________________________________________________
Mailing Address _________________________________________________
_________________________________________________
Telephone Number _____________________ Email ______________________
Please select one Employee Student Other
Respondent(s)
Name: _____________________________________________________________
Name: _____________________________________________________________
Description: Date and place of alleged violation; the nature of the alleged violation, detailed
description of the conduct of the violation:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
List any Witnesses:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Signature: ___________________________________ Date: ________________________
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Sexual Harassment Formal Complaint Form (White Earth Tribal and Community College)

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Completed 29 January 2021

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