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Discriminaon, Harassment and AssaultStatement OutlineInstrucons:  Please complete all secons below. If addional space is needed, expand each secon to use as much space as you need to complete the outline. Once completed, please return the outline and any supporng documentaon to [email protected]. NAME:INDIVIDUAL(S) AGAINST WHOM THE CLAIM IS DIRECTED:BASIS ON WHICH YOU ARE ALLEGING DISCRIMINATION (e.g. Race, Disability, Gender): BASIS ON WHICH YOU ARE ALLEGING HARASSMENT AND/OR ASSAULT: WRITTEN STATEMENT (Include a wri3en outline of events nong speci5c dates, mes, and locaons):SUPPORTING DOCUMENTATION (e.g. courseroom messages, discussion posngs and/or responses, external email):DESIRED RESOLUTION OR CORRECTIVE ACTION:

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