Discrimination, Harassment, or Misconduct Complaint

Discrimination, Harassment, or Misconduct Complaint Form
Name

First NameLast Name
Student/employee ID
Email
example@example.com
KCC Status: (you may choose as many as apply)

EmployeeStudentOther
Specify Other status
Phone number
Basis of discrimination/harassment/misconduct (you may choose as many as apply by holding down the control key)
Are you the victim?

YesNo
Victim's name

First NameLast Name
If known, please provide information below. The "respondent" is the individual accused of perpetrating the violation or harm. If there is more than one respondent who needs to be listed, please note that in the description of events.
Respondent name

First NameLast Name
Describe the incident(s) with name(s), date(s), time(s) and location(s), if possible.*
Witnesses
Would you like to propose a resolution?*

YesNo
How would you like the situation to be resolved?
Should be Empty:

Discrimination, Harassment, or Misconduct Complaint Form