Add Discrimination Complaint

Complaints by individuals who believe themselves to have been harmed by discrimination, discriminatory harassment or retaliation based on a protected class status covered by law or UAB policy, may be filed with the UAB Office of the Vice President for Access & Engagement.

All complaints of discrimination and/or harassment should be filed as soon after the alleged incident or conduct as possible. In all situations, complaints are treated with the greatest degree of confidentiality possible and maintained on a strict need-to-know basis; however, confidentiality is maintained to the degree that it does not interfere with the University’s obligation to investigate allegations of misconduct that may require corrective action.

To file a complaint, please complete the online UAB Discrimination Complaint Form below. Upon receipt, a representative from the Office of the Vice President for Access & Engagement will contact you within 3 business days.

For all emergencies, call 911.

Complainant Identification Information (all optional when submitting anonymously)

Name

Department/Company

Work Telephone

Home Telephone

Work Address

City

State

Zip

Home Address

City

State

Zip

Employee Number

Student Number

Supervisor Name

Supervisor Telephone

Contact Information

How would you like to be contacted?

Phone

Email Address

Phone Number

Have you brought this matter to the attention of any other departments(s) within the university?Required

Yes

If Yes, please list the name(s) and departments(s) of all other persons with whom you have discussed this matter. 4000 characters left

Have you brought this matter to the attention of any person or agency outside of the university?Required

Yes

If Yes, please list the name(s) or agencies(s) with whom you have discussed this matter. 4000 characters left

Complaint

Date of First IncidentRequired

Date of Last IncidentRequired

Explain how you believe you were discriminated against (treated differently from other faculty, staff or students). Please summarize below and attach additional pages describing your compaint if necessary. 4000 characters left

Name of person or persons you believe discriminated against you and the nature of the contact you have/had with them, e.g. supervisor, co-worker, faculty, customer, etc... 4000 characters left

Describe the corrective action you are seeking. Attach additional pages if necessary. 4000 characters left

For retaliation complaints, please explain why you believe someone retaliated against you. 4000 characters left

Witnesses (The relationship information requested means co-worker, supervisor, customer, faculty, etc.)

Name

Relationship

Phone

Name

Relationship

Phone

Name

Relationship

Phone

Discrimination Complaint Form

My Relationship to UAB

Complainant Identification Information (all optional when submitting anonymously)

Contact Information

Type of Complaint

Allegation based on:Required

Complaint

Attachment(s)

Signature