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Harassment Complaint Testimony Form A

Use this form to describe a harassment claim in your own words, including detailed information about verbal or physical harassment. Your information will be kept confidential. Confirm the provided details are accurate and complete.

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Harassment Complaint Testimony Form A

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  1. Complainant Testimony-Form A This form is to be used for describing a claim of harassment in your own words. For verbal complaints of harassment, documentation should include detailed conversations. If physical, please describe the specific conduct and include all detailed information including who, what, when, where and how. Be as methodical as possible. Information regarding alleged harassment shall be kept confidential to every extent possible. This complaint is filed based on my honest belief that I have been harassed. I hereby certify that the information I have provided in this statement is true, correct, and complete to the best of my knowledge. Complainant: Date: Received By: Date: Investigative Representative for the Title IX Coordinator

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