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Compliance Concern

  1. Gender

  2. Category of Discrimination

  3. Identify Race of the Complaint

  4. Describe the nature of the action, decision, or conditions of the alleged discrimination. Explain as clearly as possible what happened and why you believe your protect status was a factor.

  5. If you feel that you have been retaliated against, separate from the discrimination alleged above, please explain the circumstances.

  6. Provide the name and contact information for any person(s) whom we may contact for additional information

  7. Have you filed, or intend to file, a complain with the following?

  8. Briefly explain what remedy or action you are seeking for the alleged discrimination

  9. Leave This Blank:

  10. This field is not part of the form submission.