Complaint Form

  Click here for Chancellor’s Regulation A-830
Select One:
First Name:   Last Name:  
If an employee, please provide Job Title (otherwise leave blank):
Job Title:
If you are a parent, type student's first and last name (otherwise leave blank):
Student's First Name: Student's Last Name:
Home Address:    
Home Phone:   -    -   
Cell Phone:    -    -   
Work Phone:   -    -      Ext:   
Note: This must be your valid email address or you will not be able to submit this complaint.

Complaint Request

This is a request to OEO for a formal investigation of a complaint of alleged discrimination.
First Name of Principal or Head of Site:   Last Name:  
Title: School/Office/Region:
Site Address:   Site Phone:   -    - 

Nature of Complaint

1. Check below why you were discriminated against:
Name(s)/Title(s) of person(s) you believe discriminated against you:  
Title First Name Last Name
3. Where did it take place : (Please provide site name & address)
(Maximum 8,000 characters)
4. Date(s) on which alleged act(s) of discrimination occurred:
(MM/DD/YYYY - Please separate multiple dates with commas. Maximum of 50 characters.)
5. Explain what happened:
(Maximum 8,000 characters)
6. What relief or corrective action are you seeking?
(Maximum 8,000 characters)
Hardcopies of existing documents which you intend to submit that support this complaint must be received within 5 working days from the date of this submission. Failure to submit supporting documentation during this period may impede the process.

* Once you submit this complaint, please check your email for email confirmation.