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Request Information
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Academics & Training
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Nursing and Health Professions
Technical Programs
Online Programs
Transfer to a 4 Year
Earn College Credit in High School
Transcript Request
Student Experience
Academic Tutoring
Bookstore
Career Services
Counseling Resources
Disability Services
Library Services
Student Involvement
Academic Calendar
Business & Industry
Workforce Training
Customized Training and Technical Assistance
About New River CTC
About Us
College Directory
Employment Opportunities
Leadership & Administration
Locations
Raleigh County Campus
Advanced Technology Center
Greenbrier Valley Campus
Mercer County Campus
Nicholas County Campus
Newsroom
New River CTC Foundation and Alumni
Investigative Complaint Form
Are you a student or employee?
*
Student
Employee
Reporting Party Name:
*
First
Last
Address:
*
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Telephone Number:
*
Cell Phone Number:
*
Email Address:
*
Please indicate the type of harassment or discrimination:
*
Age (40 and above)
Sex
Color
Disability (physical or mental)
Service in the Uniformed Services
Retaliation
Race
Religion
National Origin/Ancestry
Genetic Information
Age 40 & above (employment only)
Any Age (employment only access to, and participation in, educational programs and activities)
Genetic Information (employment only)
Pay (emploment only)
Other
(Check all that apply)
Please explain:
*
Please identify the person(s) you are alleging harassed or discriminated against you:
*
Name
Title
Address
Telephone Number
When and where did the alleged discriminatory act take place?
Indicate most recent incident(s) first.
Explain clearly the events that occurred.
*
When alleging discrimination, include how you believe you were treated differently from other persons. You may attach any written documentation pertaining to this matter, such as emails or letters you received from the alleged respondent(s).
File
Drop files here or
Select files
Max. file size: 256 MB.
List any witnesses, you believe had direct knowledge of your allegation that we may contact for additional information to support or clarify your complaint.
*
Name
Title
Address
Telephone Number
What resolution do you seek?
*
Additional Comments:
Confirmation:
*
I attest that the information provided is true and accurate to the best of my knowledge.
I am aware that filing a false complaint or providing false statements may lead to stringent disciplinary measures, including suspension, dismissal, or expulsion as well as possible legal recourse by the parties involved in the complaint.
Consent
I agree to the privacy policy.
Signature
*
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