Citizen Compliment / Complaint of Employee

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University Police

MTSU Box 141
Murfreesboro, TN 37132
615-898-2424

Citizen Compliment / Complaint of Employee

Name:

Date of Birth:

Phone Number:

Driver License Number:

Address:

City:

State:

Zip Code:

Name(s) of Employee(s) Involved, if known

Date:

Time:

Location:

Details: Please describe the incident, including names, times, locations, witnesses, and any other relevant information.

I swear or affirm that the statements I am reporting in this compliment/complaint are true and accurate to the best of my knowledge, with the understanding that providing false information about a complaint is a crime. TCA: 39-16-502

Middle Tennessee State University does not discriminate against students, employees, or applicants for admission or employment on the basis of race, color, religion, creed, national origin, sex, sexual orientation, gender identity/expression, disability, age, status as a protected veteran, genetic information, or any other legally protected class with respect to all employment, programs, and activities sponsored by MTSU. The Interim Assistant to the President for Institutional Equity and Compliance has been designated to handle inquiries regarding the non-discrimination policies and can be reached at Cope Administration Building 116, 1301 East Main Street, Murfreesboro, TN 37132; Christy.Sigler@mtsu.edu; or 615-898-2185. The MTSU policy on non-discrimination can be found at mtsu.edu/iec.

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