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Complaint Form

Please identify your relationship with Lenoir Community College (LCC):

Have you brought this matter to the attention of any other department(s) at LCC? If so, please list the name(s) and department(s) of all other persons with whom you have discussed this matter.

Complaint Type - Select all that apply:

 Age Color Disability Genetic Information National Origin Political Affiliation Race/Ethnicity Religion Retaliation Gender Identity Sex Sexual Harassment Sexual Orientation Sexual Assault Veterans Status Other Pregnant/Parenting Rights

Describe your complaint and include relevant dates that the alleged behavior occurred. Please summarize below.

Name of person or persons you believe discriminated against you and why you have contact with them (i.e. Supervisor, co-worker, faculty, customer)

Name of witness(es) and your relationship to them. Please include contact information if known

Additional Information:

Please leave this field empty.