On what basis do you believe you have been harassed or discriminated against? Please check all that apply:
Who do you believe harassed and/or discriminated against you?
Describe below what you believe the person who harassed and/or discriminated against you did or did not do: *
Describe why you believe the harassment and/or discrimination is based on your race/color, disability, sex, religion, national origin/ethnicity/ancestry, veteran status, marital/parental status, sexual orientation, gender identity/expression, or retaliation based on a protected activity? *
What harm, if any, was caused to you as a result of the harassment and/or discrimination? *
Have you filed this complaint with any other Federal, State, Local Agency or any Federal, State Court, or administrative tribunal (EEOC, OCR, Kansas Commission on Human Rights)? *