MILWAUKEE AREA TECHNICAL COLLEGE

                       Discrimination Complaint Form

Name ________________________________________________________
Address ______________________________________________________
City/State _____________________________________________________
Telephone _____________________________________________________
Work Phone______________

Please provide the following information regarding the individual(s) or the
department against whom you are filing the complaint:

Name____________________________________________________________________
_________________________________________________________________________
Department________________________________________________________________
Campus __________________________________________________________________

CAUSES OF DISCRIMINATION (Please check all that apply):

       ____Age                  ____National Origin
       ____Arrest/Conviction    ____Race
       Record                   ____Harassment (including sexual
       ____Color                harassment)
       ____Creed                ____Sex
       ____Disability           ____Sexual Orientation
       ____Marital Status       ____Other _____________________
                                  (please describe)

IN REFERENCE TO:

       (Employees)               (Students)

       ____Discharge             ____Grades
       ____Hire                  ____Counseling
       ____Promotion             ____Financial Aid
       ____Recruitment           ____Training and/or Apprenticeship
                                 ____Classroom Activity
       Other (please describe) ___________________________________

PLEASE PROVIDE THE FOLLOWING INFORMATION:

1. Explain the details of the alleged discriminatory act.
2. When and how did the alleged act take place?
3. How were others treated differently?
4. Specify the action you are requesting to correct this situation.
5. Please list any witnesses.
(Attach additional pages or use the back if necessary.)

 _______________________________      __________________
 Complainant Signature                Date
 ______________________________       __________________
 Department Official Signature        Date