4000.1
4200.1
COMPLAINT FORM REGARDING SEX DISCRIMINATION (OTHER THAN SEXUAL HARASSMENT UNDER TITLE IX) (PERSONNEL)
This complaint form should be used for complaints of sex discrimination as defined on page 1 of the Board’s Administrative Regulations regarding the Prohibition of Sex Discrimination and Sexual Harassment (Personnel)
Name of the complainant ________________________________________________
Date of the complaint ______________________________________________________
Date of the alleged sex discrimination ____________________________________
Name or names of the sex discriminator(s) ____________________________________
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Location where such sex discrimination occurred ______________________________
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Name(s) of any witness(es) to the sex discrimination _____________________________
_________________________________________________________________________
Detailed statement of the circumstances constituting the alleged sex discrimination
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Remedy requested_________________________________________________________
Signature: ______________________________