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Get Cif (2/2010) 0bcomplaint Information ... - Purdue University - Purdue

Espondent: Campus Phone: Position/Status of Respondent: Relationship to Complainant: Respondent s Supervisor s Name: Sex: Male Female 10B 11B Campus Address: 12B 13B 14B 15B NATURE OF COMPLAINT 1B Harassment Discrimination ALLEGATION BASED ON Race or Color Sex Ancestry National Origin Parental Status Religion Disability Veteran Status Age (40 or over) Marital Status Sexual Orientation Sexual Harassment Retaliation Other, Explain: INCIDENT INVOLVED 2B Terms and/or Conditions.

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