The information on this form and any documentation regarding your compliance concern/ complaint is confidential. If you need assistance completing this form, please call 405-595-4418.
Last Name *
First Name*
M.I.
Email Address
Street Address
Apt/Suite#
City
State
Zip Code
Phone Home/Primary
Phone Cell/Secondary
Complaintant: * High School Student Full Time Adult Student Part Time Adult StudentShort Term Adult Student Employee Parent/GuardianCommunity Citizen
Date of Incident*
MonthMonthJanFebMarAprMayJunJulAugSepOctNovDec
DayDay12345678910111213141516171819202122232425262728293031
YearYear20192020202120222023
Type of Complaint: * Age Discrimination Domestic/Dating ViolenceGender Discrimination Gender IdentityGenetic Information Harassment/Bullying Medical Condition National Origin Pregnancy Race/Color Religion Rape Retaliation Sexual Assault Sexual Harassment Veteran Status Other
Details Basis of Complaint *