503.5E3-Disposition of Complaint Form

DISPOSITION OF  COMPLAINT FORM

Date:_____________________________________________________

Date of initial complaint:_____________________________________________________

Name of Complainant (include whether the Complainant is a student or employee):

________________________________________________________________________________________

Date and place of alleged incident(s):

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

Name of Respondent (include whether the Respondent is a student or employee):

________________________________________________________________________________________

Nature of discrimination, harassment, or bullying alleged (check all that apply):

Summary of Investigation: ___________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

I agree that all of the information on this form is accurate and true to the best of my knowledge.Signature:

_____________________________________Date: __________________________