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QUITY COMPLIANCE COMPLAINT FORM FOR DISCRIMINATION, HARASSMENT, OR RETALIATION BASED ON ONE OR MORE PROTECTED CLASS CATEGORIES If you are unable to complete this form for any reason, please contact the office for assistance. 1 Complainant s Name: 2 Complainant s Ethnicity/Race: 3 Complainant s Gender: Male Classification: Staff 4 Faculty Female Graduate Student Undergraduate Student Postdoctoral Trainee Other (Please specify: ) Home Address: Work.

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