104.E3 - Disposition of Complaint Form (Dec 2025)

DISPOSITION OF COMPLAINT FORM

Date:

_____________________________________________________

Date of initial complaint: 

_____________________________________________________

Name of Complainant (include whether the Complainant is a student

or employee):  

_____________________________________________________

_____________________________________________________

Date and place of alleged incident(s): 

_____________________________________________________

_____________________________________________________

Name of Respondent (include whether the Respondent is a student or employee): 

_____________________________________________________

Summary of Investigation: _______________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

I agree that all of the information on this form is accurate and true to the best of my knowledge. 

Signature: _____________________________________ 

Date:  _________________________