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):
_____________________________________________________
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: __________________________
