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ACAB-E

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


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