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.

Discrimination/Harassment - Complaint Form

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 Student
Short Term Adult Student
Employee
Parent/Guardian
Community Citizen

Date of Incident*

Month

Day

Year

Type of Complaint: *
Age Discrimination
Domestic/Dating Violence
Gender Discrimination
Gender Identity

Details Basis of Complaint *

 



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