Wash. Admin. Code § 132C-285-220
Discrimination/Harassment Complaint Form*
This form is designed to assist you with filing a discrimination and/or harassment complaint. Please write clearly and focus on the alleged discriminatory and/or harassing conduct. The complaint should include as much information regarding the incident giving rise to the complaint as possible, including the location, date and time of the alleged incident(s); the name of the individual or group whom the complaint is against, if known; the name of any witnesses of which you are aware, if known; a description of the incident(s); and the remedy sought.
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Name filing the complaint Date
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Signature Date
You may use the back side of this sheet if needed.
* Please return this form to the Title IX/EEO coordinator.
Wash. Admin. Code § 132C-285-220