Grievance Procedure for Discrimination Reporting Form

Background Information

Your full name:

Your role:

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(Student, Employee, Applicant/Job Seeker

Your phone number:

Your email address:

Email address must be of a valid format.

Nature of this report(Required):

This field is required.

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Please mark if you're a student, employee, applicant, witness

Date of incident(Required):

This field is required.

Involved Parties

Name

Select Role

Phone number

Email address

Questions

Is this a level 1 grievance resolution?(Required) This field is required.

If Yes, please describe the resolution achieved and name the parties involved in the resolution. This field is required.

Is this a Level 2 grievance? If yes, please continue with answering all the remaining questions on the form. If no, please review the grievance procedure for guidance (found at the top of this form). This field is required.

What steps have been taken thus far in pursuing resolution? This field is required.

Please provide a detailed Descritption/Narrative of the incident(s). This field is required.

Were there any witnesses to the incident(s)? If so, Please list their name and contact information (if available). This field is required.

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Email me a copy of this report

Background Information

Involved Parties

Questions

Supporting Documentation

Submission