EO Reporting Form

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EO Reporting Form

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Equal Opportunity and Non-Discrimination Policy
EO Reporting Form

EO Reporting Form

Please use this form to report a EO Violation or a discrimination incident

* First Name

* Last Name

* Phone Number

* Email

Street Address

City

State

Zip

* What is your relationship to MSJ?

I am the

I believe I have been, I have witnessed, or I received information that discrimination and or harassment has taken place on the basis of:

* I believe I have been retaliated against because I opposed that which I believe to be unlawful discrimination in employment or education, filed a complaint, participated in an investigatory process, or reported such behavior required.
Yes No

Involved Parties
Please provide the names and roles of individuals or organizations involved in the incident. Please complete as much of the other requested information as possible.

Click the button labeled Add Party to include more people.

Please add at least one involved party.

Describe in detail each discriminatory and/or harassing behavior that occurred. Please include dates and locations of each action.

Please add at least one incident.

Describe what remedy/desired action you are seeking and why.

If you have any additional documents, emails, or other materials that will assist us in understanding your complaint, please email them to the EO Coordinator – Teri Compton, teri.compton@msj.edu