Witness Disclosure Form

Departments

Code No. 102-E(5)

Witness Disclosure Form

Witness Disclosure Form Code No. 102-E(5)

This field is for validation purposes and should be left unchanged.
Name of Witness:(Required)
MM slash DD slash YYYY
MM slash DD slash YYYY
Name of Complainant:(Required)
Indicate if the Complainant is a student or employee.(Required)
MM slash DD slash YYYY
Nature of discrimination, harassment, or bullying alleged (check all that apply):(Required)
Acknowlegement of Accuracy(Required)