AFFIRMATIVE ACTION COMPLAINT FORM “A” FROM: , Complainant TO:, Affirmative Action Officer DATE: DESCRIPTION OF INCIDENT OF DISCRMINATION SIGNATURE This Complaint is filed by: The Complaint refers to This Complaint is in specific regard to: discrimination on: (please check one) (please check one) (please check one) An employee Race School or classroom practice A student Age An applicant Religion An employment practice A parent National Origin Other Sexual Orientation Gender Handicap RESULT OF INVESTIGATION Date Complaint Received: Affirmative Action Officer:
AFFIRMATIVE ACTION COMPLAINT FORM “A” FROM: , Complainant TO:, Affirmative Action Officer DATE: DESCRIPTION OF INCIDENT OF DISCRMINATION SIGNATURE This Complaint is filed by: (please check one) The Complaint refers to discrimination on: (please check one) This Complaint is in specific regard to: (please check one) An employee A student An applicant A parent Other Race Age Religion National Origin Sexual Orientation Gender Handicap School or classroom practice An employment practice RESULT OF INVESTIGATION Date Complaint Received: Affirmative Action Officer:
AFFIRMATIVE-ACTION-GRIEVANCE-FORM-A.docx