Code No. 104.E3
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: _________________________