Medical University of South Carolina
Equal Employment Opportunity/Affirmative Action Office
20 Erhardt Street - Unit #2
Charleston, SC 29424
(843)792-1568/1282

Harassment Discrimination Complaint Form

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

NAME(S)

DEPARTMENT___________________________________________________________

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 ?