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Office of Equal Employment Opportunity/Affirmative Action

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Medical University of South Carolina
Equal Employment Opportunity/Affirmative Action Office
20 Erhardt Street - Unit #2
Charleston, SC 29424

Harassment Discrimination Complaint Form

1. PERSON(S) INVOLVED Please list the person who is directing this harassment towards you.



Age____________ Ethnicity__________  Gender _________

Are there others involved in this harassment towards you? Yes _____ No_____ if yes, please fill out a form for each additional person. What position does this person hold on campus?


 2. LOCATION Where did the incident(s) occur ?