​​Discrimination Complaint

I am a State Employee, and I am filing a complaint for someone else...

​​Below is the form to fill out if you are a State Employee and you are submitting information of a discrimination complaint for someone else.  Fields marked with a red asterisk are required.  When you have completed filling out the form, click on the Submit button at the bottom.

If this is the incorrect form, click on the Home button above to return to the main page.

Contact Information

Name

Phone and Email

Employment Information

Mailing Address

Information Of Individual You Are Filing For

Name

Phone and Email

Employment Information

Supervisor Information

Complaint Information

Your Complaint of Discrimination is made against:

Respondent Contact Information

Dates Discrimination Occurred

Your claim of discrimination is based upon (check all that apply, and at least one must be checked):

Retaliation

Describe The Discriminatory Conduct

Additional Information

Acknowledgement

Acknowledgement

You can upload a maximum of 5 files, each up to 10MB.
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