ADMINISTRATIVE COMPLAINT FORM

(PLEASE PRINT ALL INFORMATION) PERSON BRINGING COMPLAINT (Complainant/Plaintiff) Name of Complainant: Address: Occupation (Course, year and section if a student/ Position and department if an employee): Phone Number: E-mail Address: PERSON/STUDENT AGAINST WHOM COMPLAINT IS BROUGHT (Accused/Respondent) Name: Address: Occupation (Course, year and section if a student/ Position and department if an employee): Phone Number: DESCRIPTION OF VIOLATION WHAT: WHERE: WHEN: WHO: HOW: WHY: (Please explain the basis for your complaint. State detailed facts and circumstances, including names of persons whom you believe have knowledge of the facts. If necessary, attach additional sheets.) RELIEF PRAYED FOR: I swear under oath that all statements made in this complaint are true and correct. Signature of Complainant:_______________________Date:_______________________ Printed Name:_________________________________ Investigation and interview was conducted by: Signature:____________________________________Date:_______________________ Printed Name:_________________________________ Cc: