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Activities & Forums
College Now
Dual Credit Programs
Kenora Catholic District School Board
Keewatin-Patricia District School Board
Lakehead Public School Board
Rainy River District School Board
Superior-Greenstone District School Board
Thunder Bay Catholic District School Board
Future Students
Orientation
Visit Us
Book a Tour
About Confederation College
Thunder Bay and Region
Our Campuses
Thunder Bay
Dryden Campus
Greenstone (Geraldton)
Red Lake
Sioux Lookout
Lake of the Woods (Kenora)
Northshore Campus (Marathon)
Rainy River (Fort Frances)
Recruitment Team
SUCCI - Your Student Association
On Campus Services
Residence
Amenities & Service
Alumni Service
Cafeteria - Sodexo
Children and Family Centre
Co-op and Work Placement
Dental Clinic
Facilities Services
Library
Northwest Employment Works
Parking
Residence
Security Service Training
Wellness Centre
Program Coordinators
How to Apply
How to Confirm
Current Students
Registrar’s Office
Finances
Financial Aid
How to Pay
Residence
SUCCI - Your Student Association
Oshki Anishnawbeg Student Association OASA
Student Support Services
Student Life
Wellness Centre
Domestic Student Health Plan
Thunderhawks Athletics
Student Jobs on Campus
Convocation
Graduation Portraits
Post Graduate Employment
Convocation Books
Student Success Stories 2021
Indigenous Students
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Indigenous Scholarships, Bursaries and Awards
Indigenous Student Recruitment
Viewbook
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Indigenous Self-Identification
Indigenous Staff/Contact Us
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Racism Complaint Intake Form
Submissions can be made anonymously
Complainant Information
I am a
student
community member
employee
Program
Relationship to College
Position Title
Department
Respondent Information
The respondent is a
student
community member
employee
The respondent is the individual in which the complaint is made against. If the complaint has more than one Respondent, please complete a separate complaint form for each.
Program
Relationship to College
Position Title
Department
Description of Allegations
Please describe, in as much detail as possible, the incident(s) of alleged harassment.
*
Please include: who was involved; what was specifically said or done (words, tone, actions, etc.); when it happened (dates and times); where it happened; any witnesses to the incident(s) described (names and contact information, if possible); how the incident(s) impacted you; and if the incident(s) was reported to management (please provide details: who, when, what action was taken, etc.).
When did the alleged harassment begin? When did the most recent incident of alleged harassment occur?
*
Summary Information
Involves multiple incidents of alleged harassment
Involves a single incident of alleged harassment
Involves physical contact and/or assault
Involves verbal abuse and/or threats
Involves reprisal and/or retaliation
Involves abuse of authority (use of authority serving no legitimate work purpose)
Involves sexual harassment (harassment which is gender-based/of a sexual nature)
Involves discriminatory harassment (based on prohibited ground of discrimination)
What prohibited ground was the basis of the alleged harassment?
Where did the alleged harassment primarily occur?
*
Statement of Acknowledgement
Name
Date
*
Submit
Agreed
By checking this box and hitting 'Submit', you certify the information provided in this complaint to be accurate, true and complete to the best of your knowledge.
I certify the information provided in this complaint to be accurate, true and complete to the best of my knowledge. I understand that I will not be subject to any adverse treatment as a result of making this complaint, provided that it has been made in good faith and without malice. I acknowledge that, in order to preserve the integrity of the process and to protect the interests of all parties, I will maintain confidentiality and will not discuss this complaint with anyone other than those who need to know (i.e. union representative, Equity and Human Rights Advisor, investigators, legal counsel, health care providers, EAP, counsellors, and/or management representatives). I understand that the College will maintain confidentiality of any information gathered as a result of this complaint, but will share such information as necessary to pursue resolution, including disclosing the complaint and related information to the Respondent or as otherwise required by law. I acknowledge that filing this complaint does not prevent me from pursuing any other remedies that may be available (e.g. grievance, Human Rights complaint, legal action, etc.), which are separate and distinct from the Policy. I acknowledge that it is not the role of the Equity and Human Rights Advisor to identify any remedies or procedures that are or may be available outside the Policy and that I am solely responsible for exploring such options should I choose to do so.
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