ACAB-E: HARASSMENT COMPLAINT FORM
Name of complainant:
Position (circle one): Student Teacher Secretary Custodial Other
Date of complaint:
Name of the alleged harasser:
Date and Location of incident(s):
Description of the alleged harassment:
Name of witnesses:
Evidence of harassment (i.e. photos, letters, etc.) Attach and list items:
Other pertinent information:
Signature of Complainant / Date Signature of Reporting Officer / Date
SOURCE: Georgetown
Adopted on: September 27, 2007