LCUA Employment Complaint Form On-line

INSTRUCTIONS:

Plase answer all the questions and then click on "submit".

To: Latino Committee on University Affairs (LCUA)

From:

E-mail:

Home Address:

Work Department:

Phone: (Home): (Work):

NATURE OF COMPLAINT:

(Please describe the situation:)

CAUSE OF COMPLAINT

I think the situation has occurred because:

REMEDY

How would I like this situation to be corrected:

WITNESSES

Other individuals I think you should speak with:

The person accused of wrong-doing:
Persons who have first-hand direct knowledge:
Persons who have first-hand direct knowledge:
Persons who have first-hand direct knowledge:

I understand that this form will be used to write a general report on the status of Latinos and that if I want further action to be taken this form will be forwarded to the office of affirmative action.

Name:

Date: