Fillable Touro College and University System Complaint Form for Reporting Sexual Harassment

Fill Online, Printable, Fillable, Blank Touro College and University System Complaint Form for Reporting Sexual Harassment Form

Use Fill to complete blank online TOURO COLLEGE pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Touro College and University System Complaint Form for Reporting Sexual Harassment

On average this form takes 7 minutes to complete

The Touro College and University System Complaint Form for Reporting Sexual Harassment form is 3 pages long and contains:

  • 1 signature
  • 19 check-boxes
  • 14 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Touro College

BROWSE TOURO COLLEGE FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
TOURO COLLEGE AND UNIVERSITY SYSTEM
COMPLAINT FORM FOR REPORTING SEXUAL HARASSMENT
New York State Labor Law requires all employers to adopt a sexual harassment prevention policy
that includes a complaint form for employees to report alleged incidents of sexual harassment.
If you believe that you have been subjected to sexual harassment, you are encouraged to complete
this form and submit it to
For all Touro complaints, please contact:
Matthew Lieberman
Title IX Coordinator
Touro College
500 Seventh Avenue, 4th Floor
New York, NY 10018
Phone: 646-565-6000 x55667
Email: matthew.lieberman@touro.edu
For all New York Medical College complaints, please contact:
Katherine Dillon Smith, M.S.W.
Title IX Coordinator
New York Medical College
40 Sunshine Cottage Road
Valhalla, NY 10595
Phone: 914-594-4527
Email: Katherine_Dillon@NYMC.edu
Once you submit this form, Touro will follow its sexual harassment prevention policy and investigate
any claims.
If you are more comfortable reporting verbally or in another manner, Touro will continue to follow
its sexual harassment prevention policy by investigating any claims, as outlined at the end of this
form.
For additional resources, visit: ny.gov/combatting-sexual-harassment
COMPLAINANT INFORMATION
Na
me: ___________________________________
Home Address: ___________________________________
Phone: ___________________________________
Job Title: ___________________________________
Email: ___________________________________
Select Preferred Communication Method: (please select one)
Phone Email
1. Your complaint of Sexual Harassment is made against: ___________________________________
Name: ___________________________________
Title: ___________________________________
Address: ___________________________________
Phone: ___________________________________
Relationship to you:
Supervisor Subordinate Co-Worker Professor
Student Admin Other
2. Please describe the conduct or incident(s) that is the basis of this complaint and your reasons for
concluding that the conduct is sexual harassment. Please use additional sheets of paper if necessary
and attach any relevant documents or evidence.
3. Date(s) sexual harassment occurred: ___________________________________
Is the sexual harassment continuing? Yes No
4. Please list the name and contact information of any witnesses or individuals that may have
information related to your complaint:
The last two questions are optional, but may help facilitate the investigation.
5. Have you previously complained or provided information (verbal or written) about sexual
harassment?
Yes No
If yes, when and to whom did you complain or provide information?
Employees that file complaints with their employer might have the ability to get help or file claims
with other entities including federal, state or local government agencies or in certain courts.
6. Have you filed a claim regarding this complaint with a federal, state or local government agency?
Yes
No
Ha
ve you instituted a legal suit or court action regarding this complaint?
Ye
s
No
Ha
ve you hired an attorney with respect to this complaint?
Ye
s No
I request that Touro College investigate this complaint of sexual harassment in a timely and
confidential manner as outlined below, and advise me of the results of the investigation.
Signature: __________________________ Date: __________________
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Touro College and University System Complaint Form for Reporting Sexual Harassment

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 10 April 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document