Harassment and Discrimination Form

Thank you for completing the following form.

Your Affiliation*
Report of harassment or discrimination: a statement may include a description of what happened with as many details as you can provide (dates, times, location, who else may have been near). Supplementary materials such as pictures, emails, or texts can be attached to the email or this submission.
Affiliation of Above (If Known
Please provide a description of any resolution or remedial action you would like seen taken.
US Equal Employment Opportunity Commission, 300 Pearl Street, Suite 450, Buffalo, NY 14202; 716.551.4387; https://www1.eeoc.gov/ New York State Division of Human Rights, 44 Hawley Street, Binghamton, NY 13901; 888.392.3644; https://dhr.ny.gov/