Identify all individuals with knowledge of the conduct about which you are complaining: _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________
Acknowledgement: I,
, am willing to cooperate fully in the investigation of my complaint and will provide all information in my possession, custody or control which the College may reasonably request in connection with its investigation. I affirm that the information I am providing is true and correct to the best of my knowledge. I understand that my statements and the information that I am providing may be attributed to me and could be included in any investigation reports that are prepared. I also understand that this investigation is confidential and for me to disclose any information that I have obtained during the course of this investigation could interfere with the investigation. I also understand that if I do not fully cooperate, decisions will be made based on the best information available to the College.
Signature:
Date:
Witness:
Date:
Appendix A
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