1-800-4-ALFRED (425-3733)

Discrimination Complaint Reporting Form

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If you are reporting an emergency or an imminent threat, please contact University Police at 607-587-3999 or 911 immediately.

This form is to be used by students and employees to file a complaint of discrimination based on Race, Color, Religion, Sex, National Origin, Sexual Orientation, Veteran's Status, Age, Disability, Marital or Parental Status, or Sexual Harassment.

Question #5 below asks how you would like your complaint processed under the college's grievance procedure.


Background Information
:
Alleged Person(s)
Please indicate below who your complaint is against and whether they are an employee or student:
Complaint Details & Action Requested
Please answer the following questions:
Honesty Statement & Report Submission