Non-PSCC-Discrimination/Harassment/Sexual Misconduct Complaint Form

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Discrimination/Harassment/Sexual Misconduct Complaint Form

Institutional Compliance

Phone: 865-539-7354

Email: gtunderwood@pstcc.edu

Submission Date: 04/26/2025

Complainant Information

Last Name:

First Name:

Middle Initial:

Pnumber:

Street Address:

City:

State:

Zip:

Email:

Phone:

Type of discrimination alleged

Sexual Harassment/Sexual Misconduct

[If you do not want details of what occurred reported or are not interested in making a complaint at this time do not submit this complaint. Instead, you can contact:
Nancy T. Truett, LPC-MHSP, Director, Hardin Valley Campus, GN 130, nttruett@pstcc.edu, who is a confidential counselor/employee; WHO WILL NOT share information with the Title IX Coordinator.

Name(s) of person(s) accused of wrongdoing

Last Name:

First Name:

Middle Initial:

Pnumber:

Street Address:

City:

State:

Zip:

Email:

Phone:

Names of witnesses to the above-described events (including phone number, if known):

Last Name:

First Name:

Middle Initial:

Pnumber:

Email:

Phone:

Last Name:

First Name:

Middle Initial:

Pnumber:

Email:

Phone:

Names of anyone with whom you discussed the above-described events (including phone number, if known):

Last Name:

First Name:

Middle Initial:

Pnumber:

Email:

Phone:

Description

Describe all actions of person(s) named above.
Be as detailed as possible: include the date, time, and place of each event(s) or conduct involved.

How would you like this resolved?

What effect has this had on you ?

If you would like to attach any documentation please use the box provided.

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