COMPLAINTPROCEDURE

FORALLEGATIONSOF
DISCRIMINATION

OfficeofDiversityandAffirmativeAction
UpdatedMarchof2014

ComplaintProcedureforAllegationsof
Discrimination1

StatementofPrinciples

Stony Brook University (including Stony Brook Medicine, Long Island State Veterans
Home,andallotherStonyBrookUniversityfacilitiesandprograms),referredtoasStony
Brook or the University, has a longstanding commitment to equal employment and
educational opportunity, and environments that foster respect, dignity, fairness, and
equity.StonyBrookiscommittedtocreatingandmaintainingworkplace,educational,and
recreational environments that are safe and accessible, and free of all forms
ofdiscrimination.

In continuing Stony Brooks effort to seek equity in education and employment, and
consistent with Federal and State antidiscrimination legislation, the University has
adoptedacomplaintprocedureforthe promptand effectiveinvestigationof allegations
ofdiscriminationonthebasisofrace,color,creed,nationalorethnicorigin,religion,age,
sex, sexual orientation, gender identity, disability, military status, genetic information,
criminalconviction,domesticviolencevictimstatus,and/ormaritalstatus.Harassmenton
the basis of any of the aboveprotectedcategoriesisdiscriminatoryharassmentandisa
form of discrimination. Stony Brook shall make reasonable efforts to investigate and
addressinstancesofdiscriminationofwhichitbecomesaware,evenintheabsenceofa
complaintorcomplainantcooperation.

ApplicabilityofProcedure

This procedure applies to all complaints alleging discrimination, which include sexual
harassment, sexual assault and sexual violence, against employees, students or third
parties.2 Thisprocedureisintendedtobalancetherightsofthosebringingcomplaintsof
discrimination(theComplainant)withthoseagainstwhomsuchclaimsarebrought(the
Respondent).Throughouttheseprocedures,thepartiesshallrefertotheComplainant
andtheRespondentinvolvedinthecomplaint.

1Thisdocumentisprovidedforinformationalpurposesonly.Itisnotintendedtobeinterpreted
orrelieduponaslegaladvice.Anyoneseekingorrequiringlegaladviceshouldconsultanattorney.
2AthirdpartyreferstoanyoneoutsidetheUniversitycommunity,includingbutnotlimitedto,
guests,visitors,vendors,andvolunteers.
2

ThisproceduremaybeutilizediftheComplainantorRespondentisaStonyBrookstudent,
employee or third party, if the alleged incident(s) took place at a University facility,
program, or activity. Employee grievance procedures established through negotiated
contracts, academicgrievancereviewcommittees,studentdisciplinarygrievanceboards,
andanyotherproceduresdefinedbycontractwillcontinuetooperateasbefore.

ExternalAgencies
This proceduredoes not deprive a Complainantof the right to file a complaint with
outside enforcementagencies, such as the New York State Division of HumanRights,
the United States Equal Employment Opportunity Commission, the Office for Civil
Rights of the United StatesDepartmentofEducationandthe OfficeofFederalContract
ComplianceoftheUnitedStatesDepartmentofLabor.AComplainantmayfileachargeof
discrimination withtheappropriatestateand/orfederalenforcementagenciesatanypoint
intheprocess,subjecttoapplicabletimelimitations. Itisimportanttonotethatfilingan
internalcomplaintpursuanttothisproceduredoesnotextendthetimelimitsestablished
bystateandfederalenforcement agencies. Alistofstateandfederalenforcementagencies
arelistedinAppendixA.

Uponfilingwithanexternalagency,theStonyBrookinternalcomplaintmaybereferred
totheOfficeofGeneralCounselforreview,defenseor,ifdeemedappropriate,mediation,
conciliation,orsettlementwiththeexternalagency,orsuchotheractionsasmaybeinthe
interestsoftheUniversity,includingtheterminationoftheinternalprocess.

JurisdictionoftheOfficeofDiversityandAffirmativeActionisnotExclusive

The Universitywillinvestigateallegedactsofdiscriminationof which it becomesaware.

BasedoninformationreceivedbytheOfficeofDiversityandAffirmativeAction(referred
toasODAA),theODAADirectorordesigneemayexercisehis/herowndiscretionand
initiate an investigation in the absence of a complaint. Depending on the circumstances,
allegationsofdiscriminationmayalsobereferredtoand/orinvestigatedbyODAAand
otherUniversityoffices,includingEmployeeandLaborRelations(LaborRelations)and
StudentAffairs.

If at any time during the course of investigating a complaint the ODAA Director or
designee determines that a complaint is not within the jurisdiction of the office, the
complaintandtheComplainantshallbereferredtotheappropriateofficeandthematter
shall be considered concluded by ODAA. The ODAA Director or designee may
determinethataspecificcomplaintis of such a serious nature that themattermustbe
referred immediately to the appropriate University office. The University Police
Departmentmayalsobecomeinvolvedifcriminalconductisimplicated.
3

TheFollowingShouldbeReportedtoODAAforInvestigation
Discrimination
AllallegedviolationsofStonyBrookpolicy,whichprohibitsdiscriminationonthebasisof
race, color,creed,nationalorethnicorigin,religion,age, sex,sexual orientation,gender
identity, disability, military status, genetic information, criminal conviction, domestic
violencevictimstatus,and/ormaritalstatus,shouldbereportedforinvestigation.
DiscriminatoryHarassment
Discriminatoryharassmentisaformofdiscrimination,whichisprohibitedandshouldbe
reported.Discriminatoryharassmentisimproperconducttowardaparticularindividual,
individuals,orgroupsonthebasisofoneormoreofthecategoriesindicatedabove,
whichissufficientlysevereorpervasivethatithasthepurposeand/oreffectof:
Creatinganintimidating,hostile,oroffensiveworkoreducationalenvironment
forindividualsand/orgroups;or

Unreasonably interfering with the work, academic performance, living

environment, personal security, or participation in any Universitysponsored
activityofindividualsand/orgroups.

SexualHarassment
Sexualharassmentisaformofdiscriminationbasedonsex,whichisprohibitedandshould
bereported.Sexualharassmentencompassesunwelcome,genderbasedverbalorphysical
conduct, such as unwelcome sexual advances, unwelcome requests for sexual favors,
requests for sexual favors in exchange for some benefit, and/or unwelcome verbal or
physicalconductofasexualnature.Sexualharassmentoccurswhen:
Submission to such conduct is made either explicitly or implicitly a term or
conditionofanyindividualsemploymentoreducation;or

Submissiontoorrejectionofsuchbehaviorbyanindividualisusedasthebasis
foremploymentoreducationaldecisionsaffectingtheindividual;or

A behavior is sufficiently severe, persistent or pervasive to interfere with an

individuals work or educational performance, or creates an intimidating,
hostile,oroffensiveworkoreducationalenvironment.

Examplesofbehaviorsthatmayrisetothelevelofsexualharassmentinclude,butarenot
limitedto,thefollowing:
Physicalassault;

Directorimpliedthreatsthatsubmissiontosexualadvanceswillbeacondition
of employment, work status, promotion, grades, work references, or letters of
recommendation;and
4

Apatternofbehavior thatisunwelcome,and severeorpervasive,resulting in

unreasonable interference with the work, educational or recreational
environment or the creation of a hostile, intimidating or offensive work,
educationalorrecreationalenvironment,mayinclude,butisnotlimitedtothe
following:
o Commentsofasexualnature;
o Sexuallyexplicitstatements,questions,jokes,oranecdotes;
o Unnecessary or undesirable touching, patting, hugging, kissing, or
brushingagainstanindividualsbody;
o Remarks of a sexual nature about an individuals clothing, body, or
speculationsaboutsexualexperiences;
o Persistent,unwantedattemptstochangeaprofessionalrelationshiptoan
amorousrelationship;
o Subtle propositions for sexual activity or direct propositions of a sexual
nature;
o Uninvitedletters,emailmessages,textmessages,telephonecalls,orother
correspondencereferringtoordepictingsexualactivities;and/or
o Anyoftheabovecarriedoutviasocialmedia.

SexualAssault
Sexualassaultisdefinedasaphysicalsexualactoractscommittedagainstapersonwithout
their consent. Sexual assault is an extreme form of sexual harassment. Sexual assault
includeswhatiscommonlyknownasrape,whetherforcibleornonforcible,daterape
andacquaintancerape.

SexualViolence
Sexualviolenceisdefinedasanyotherformofaphysicalsexualactperpetratedagainstan
individualwithouttheirconsentorwhenapersonisincapableofgivingconsent.

TitleIXComplaints

Allindividualsreportingactsofsexdiscrimination,sexualharassment,orsexualviolence
will be informed by ODAA of their options and resources, consistent with Title IX a
federal statute that prohibits discrimination on the basis of sex. Complainants will be
provided a list of available resources, including counseling, local rape crisis center
information, medical services, police services, and state and/or federal agencies for the
filing of external complaints. Complainants will also be advised of their right to file a
complaintwithlocallawenforcementagencies.

Stony Brook will comply with law enforcement requests for cooperation, which may
require the ODAA and other University offices to temporarily suspend the factfinding
aspectofaTitleIXrelatedinvestigationwhilethelawenforcementagencyisintheprocess
of gathering evidence. Stony Brook will promptly resume its investigation as soon as
notifiedbythelawenforcementagencythatitiscompletedtheevidencegatheringprocess.
As necessary, Stony Brook will implement appropriate interim steps during the law
enforcementagencysinvestigationtoprovideforthesafetyoftheComplainantandthe
Universitycommunity,andtoavoidretaliation.

ODAAstaffmayexplaintheavailabilityofinterimmeasuresduringitsinvestigation,as
appropriate.Inthecaseofaninvestigationofpossiblesexualharassment,Complainants
may be informed as to where to obtain counseling, psychological, medical and/or
psychiatricservices.StudentComplainantsmaybeinformedaboutinterimmeasuresthat
can be taken if the Respondent lives on campus and/or attends classes with the
Complainant.ODAAstaffwillexplainthatsuchmeasuresshouldnotdisproportionately
affecttheComplainantandhe/sheshouldbereferredtoStudentAffairsforassistancewith
makingsucharrangements.

RoleoftheStaffoftheOfficeofDiversityandAffirmativeAction

The ODAA is a neutral factfinding office. Professional staff members are trained in
investigatingcomplaintsandareavailabletoassistwithfilingacomplaint.Investigations
willbeconductedinapromptandeffectivemanner.Bothpartieswillhavetheopportunity
to offer evidence to be considered. ODAA does not represent either party, but does
advocateon behalfoftheUniversitysprinciplesofequalopportunity,nondiscrimination
andequity.

TheODAAanditsDirectorreporttotheUniversitysTitleIXCoordinator,whoisalsothe
Senior Director for Title IX and Risk Management (referred to as the Title IX
Coordinator),andreportsdirectlytotheUniversityPresident.TheTitleIXCoordinator
may participate in ODAA functions, which are set forth in this procedure. The Title IX
Coordinatormaybecontactedat:

OfficeofDiversityandAffirmativeAction
StonyBrookUniversity
201AdministrationBuilding
StonyBrook,NY117940251
Phone:6316326280

ConflictofInterest
TheODAAshallreceiveanyinformationconcerninganyfactorsthatcouldprejudice an
objective evaluation of the evidence. In the event that a conflict of interest arises, the
Universitywilltakenecessarymeasurestoensurethattheinvestigationisthoroughand
impartial. These measures may include reassignment of the investigation to other
investigatorswithappropriate experienceandtraining.IfastaffmemberofODAAort h e
T i t l e I X C o o r d i n a t o r isthe Respondent, the matter maybereferredtothePresident
orhis/herdesignee.IfthePresidentistheRespondent,theODAAwillreferthecomplaint
totheOfficeofGeneralCounsel.

Confidentiality
The ODAA staff will conduct its investigation in a confidential manner to the extent
practicable and/orpermittedbylaw.Note, however, that the ODAAs factfindingmay
alsobeutilizedbyotheroffices,includingLaborRelations(asconsistentwiththecollective
bargainingagreements).Thepartiesandwitnessesareexpectedtocooperatefullyinthe
investigation,andmaintainandpreservetheconfidentialityoftheinvestigation.

FilingaComplaint

The ODAA staff may receivecomplaintsfromstudents,employeesorthirdparties, and

inquiries,reports,andrequestsforconsultationandcounseling.Acomplaintmaybefiled
witheithertheODAAortheTitleIXCoordinator(seepage12forcontactinformation).
ODAAstaffshouldbeconsultedtodiscusstheviabilityofpursuingacomplaintagainsta
thirdparty.Thisprocedureassumesthatawrittencomplaintwillbesubmitted.However,
complaintsmaybefiledorally.

Timeframe
Ordinarily,complaintsshouldbefiledwithinninety(90)daysafterthelastactofalleged
discrimination occurred. In instances involving a student complaint against a faculty
memberchargingdiscriminationthatoccurredinthecontextofasubordinatesupervisor
academicrelationship(e.g.,teaching,advising,thesisordissertationsupervision,coaching,
clinicalmedicalsupervision),thetimeperiodmaybeextendeduntilninety(90)daysafter
the student is no longer under the faculty members academic or clinical medical
supervision.

SupervisoryResponsibility
Complaints or concerns that are reported to or act(s)/conduct that is observed by an
administrator,managerorsupervisorinvolvinganallegedactofdiscrimination, should
be promptly referred to either the ODAA or the Title IX Coordinator for appropriate
action.Allotheremployeesarealsoencouragedtomakesuchreportstotheirsupervisor,
theODAAortheTitleIXCoordinator.

Retaliation

Retaliation against an employee, studentoranywitness who participatesin an ODAA

investigation pursuant to this procedure is prohibited. Retaliation is also prohibited
against any individual who files a sex discrimination complaint under Title IX or
participatesinacomplaintinvestigationinanyway.Anysubstantiatedactofretaliation
may result in sanctions or other disciplinaryaction as covered by collectivebargaining
agreements,and/orapplicableUniversitypolicies.

ProceduresforInvestigatingComplaints

ComplaintConsultation&Review
The length of time for the consultation will vary depending on factors such as the
complexityof the situation,officeworkload,or whetherthe situationinvolves actual or
imminent loss of employment or academic standing, potential physical harm, or an
ongoing relationship between the parties. In a telephone conversation or inperson
appointment,astaffmemberwill:
Receivecomplaintsofallegeddiscrimination;
Discussthefactsofasituationandhelptheindividualidentifytheproblem(s);
AssisttheComplainantintheuseoftheComplaintIntakeForm;
Determine if the ODAA is the appropriate University office to address the
allegation(s);
Inform the individual of the ways in which the O D A A approaches its
investigativeprocesses;
AdviseanindividualofalternateavailableUniversityresourcesandexternal
options;and
ProvidetheComplainantwithinformationaboutthevariousinternalandexternal
mechanismswithwhichthecomplaintmaybefiled.

Expectations
The Universitys review procedures are not designed to replicate an external judicial
process.Consequently:
ComplainantsandRespondentsareexpectedtomeetwithODAAstaffasneeded
andrequested;
During any portion of the procedures, the parties shall b e p r o h i b i t e d f r o m
u s i n g audio or videotapingdevices;
Advocates and representatives of a Complainant or a Respondent may not
participateatanymeetingconvenedbyODAA;
Respondents and Complainants are expected to communicate with ODAA
directly,notthroughlegalcounsel,otherintermediaries,orpersonsaccompanying
theparties;
TheODAAmayprovidethepartieswithperiodicupdates,asdeemedappropriate
and/ornecessary;
Asappropriate,theODAAwillprovidethepartieswithwrittennoticeofwhether
thecomplainthasbeensubstantiated.

IntakeInterview
The ODAA staff will ask a Complainantto participate in an initial intake interview, in
whichtheComplainantwillbe:
Asked to completeaComplaint IntakeForm(the Complainantmay be asked to
havethiscompletedpriortotheintakeinterview)(seeAppendixB);
Interviewedsothattheallegationsmaybeclearlystated;
Asked to provide information about witnesses and other possibly aggrieved
persons;
AdvisedofODAAsinvestigativeprocedures;
Referred to another University office if the complaint does not fall within
ODAAsjurisdiction;
AdvisedoftheUniversityspolicyagainstretaliation;
Advised of the extent to which ODAA can maintain confidentiality in the
investigativeprocess;and
Advised of the option to file a complaint with external federal and/or state
investigativeagenciesatanytime.

AftertheIntakeInterview
The ODAA staff will determine whether a complaint merits further review. If it is
determinedthataninvestigationisnecessary,theODAAwillcommencetheinvestigation
in a prompt and effective manner, pursuant to the jurisdiction requirements outlined
above.AninvestigationisstartedoncetheODAAstaffhasdeterminedthatacomplaint
meritsfurtherinvestigation,oriftheallegationinvolvessexualharassment,sexualassault
oranyformofsexualviolence.Duringthisinvestigation,theODAAstaffwill:
ReasonablyinformtheRespondentoftheComplainantsallegation(s);
ReviewallUniversityrecordsthatconcernthecomplaint;
Interviewwitnesses;
ReviewstatementsprovidedbytheComplainantandtheRespondent;
Reviewotherrelevantevidence;and
Takeallreasonablestepsnecessarytocompletetheinvestigationwithin90calendar
days after receipt of the complaint. ODAA may extend this deadline for a
reasonableperiodoftime,asneeded.ODAAwillinformthepartiesifanextension
isneeded.

EvidenceStandard
TheevidentiarystandardappliedinallODAAinvestigationsisthepreponderanceofthe
evidence.Inotherwords,thequestionthatmustbeposedandanswerediswhetheritis
more likely than not that any alleged event(s) occurred. If the answer is yes, the
complainthasbeensubstantiated.Inreachingitsfindings,theODAAstaffshallevaluate
allfactsandevidence,andconsidertheseverityandfrequencyoftheallegedact(s).

RespondentsRefusaltoCooperate
IftheRespondentisanemployeewhorefusestocooperateand/orrespondinatimely
manner,ODAAmayforegocompletionofaninvestigationandreferthemattertoLabor
Relations,asappropriate,ortheofficemaytakeanyotheractionitdeemsnecessaryand
appropriate to address the situation. If the Respondent is a student who refuses to
cooperateand/orrespondinatimelymanner,ODAAmayforegocompletionofan
investigation and refer the matter to the University Community Standards
Officeand/orStudentAffairs,asappropriate.

ComplainantsInactionorDecisionNottoCooperate
During an investigation, if a Complainant declines to cooperate with ODAA or if the
officedeterminesthattheComplainantno longerwishesto pursueacomplaint,ODAA
may consider the matter closed and may take no further action, with appropriate
notification to the parties. ODAA also reserves the right to continue its investigation,
regardlessofComplainantcooperationorinvolvement.

10

ComplaintsWithdrawalofComplaint
If a Complainant withdraws a complaint, such a decision should be communicated in
writing to the ODAA staff. The University may, nevertheless, chose to investigate the
allegation(s).

AttheConclusionoftheInvestigation
The ODAA staff issues a written statement indicating whether the complaint was
substantiated.Ifthecomplaintwassubstantiated:

(i)
For Students the ODAA may refer the matter to the University
Community Standards Office for appropriateaction(ifany)under the
applicableStudentConductCode.

(ii)
For Employees (including student employees) not in a Collective
BargainingUnitinconsultationwithLaborRelationsandtheOffice
ofGeneralCounsel,appropriateadministrativeactionmaybetaken.

(iii)

ForEmployeesinCollectiveBargainingUnitstheODAAmayrefer
the matter to Labor Relations for investigation under the applicable
collectivebargainingagreement.

Uponconcludingitsinvestigation,ODAAwillassurethatstepswillbetakentoprevent
discrimination and harassment, to prevent the reoccurrence of discrimination and
harassment,andtoremedythediscriminatoryeffectsontheComplainant(s)andothers,if
appropriate.

Appeal
Thereisnorightofappealfromthefindingsofaninvestigationconductedby
ODAA.

11

Tofileacomplaintpursuanttothisprocedure,requestassistanceorfor
additionalinformation,pleasecontact:

MarjolieLeonard
TitleIXCoordinator
InterimDirectorforTitleIXandRiskManagement
OfficeofDiversityandAffirmativeAction
201AdministrationBuilding
StonyBrook,NY117940251
Email:Marjolie.Leonard@stonybrook.edu
TitleIX@stonybrook.edu
Phone:6316326280

OfficeofDiversityandAffirmativeAction(ODAA)
WestCampusOffice
201AdministrationBuilding
StonyBrook,NY117940251
Email:ODAA@stonybrook.edu
Phone:6316326280
Fax:6316329428

OfficeofDiversityandAffirmativeAction(ODAA)
UniversityHospitalSatelliteOfficebyappointmentonly
Level5,Room624
Phone:6316326280
Fax:6316329428

Foradditionalinformation,visittheODAAwebsiteat:
www.stonybrook.edu/diversity

12

AppendixA

ExternalEnforcementAgencies

NewYorkStateDivisionofHumanRights
StateHeadquarters
NewYorkStateDivisionofHumanRights
OneFordhamPlaza
4thFloor
Bronx,NewYork10458
Tel:(718)7418400
Email:InfoBronx@dhr.ny.gov

EqualEmploymentOpportunityCommission
NewYorkDistrictOffice
33WhitehallStreet,5thFloor
NewYork,NewYork10004
Tel:(800)6694000
Fax:(212)3363790

OfficeofCivilRightsNational
Headquarters
LyndonBainesJohnson(LBJ)
U.S.DepartmentofEducationBuilding
400MarylandAve,SW
Washington,DC20202
Tel:(202)4010418
Fax:(202)2607465

LongIslandDistrict
NewYorkStateDivisionofHumanRights
175FultonAvenue,Suite404
Hempstead,NewYork11550
Tel:(516)5381360
Email:InfoLongIsland@hdr.ny.gov

OfficeofCivilRightsNewYork
U.S.DepartmentofEducation
FinancialSquare
32OldSlip,25thFloor
NewYork,NewYork10005
Tel:(646)4283906
Fax:(646)428390

NewYorkStateDivisionofHumanRights
StateOfficeBuilding
VeteransMemorialBuilding
250VeteransMemorialHighway
Suite2B49
Hauppauge,NewYork11788
Tel:(631)9526434
Email:InfoLongIsland@hdr.ny.gov

OfficeofSexualHarassment
NewYorkStateDivisionofHumanRights
OfficeofSexualHarassment
55HansonPlace,Room900
Brooklyn,NewYork11217
Tel:(718)7222060

OfficeofFederalContractCompliance
Programs
NewYorkDistrictOffice
26FederalPlaza,Room36116
NewYork,NewYork102780002
Tel:(212)2647742
Fax:(212)2648166

13

AppendixB
ComplaintIntakeForm
CASE#

STONYBROOKUNIVERSITY,OFFICEOFDIVERSITY&AFFIRMATIVEACTION
ComplaintIntake&InformationSheet

Name:

Date:

Address:

DayTelephone#:

EveningTelephone#:

Cell#:

StateEmployee
Student(undergraduate)

Maywecontactyouatwork?Yes No

Student(graduate)

1. Pleaseindicateyour:

DateofBirth:

Sex:

ReligiousAffiliation:

Race/Ethnicity:

MaritalStatus:

Jobtitle:

DateofHire:

Highestlevelofeducationcompleted:

Departmentinwhichyouwork:

SupervisorsnameandJobtitle:

2. Nameandtitleofthepersonthatallegedlydiscriminatedagainstyou:

Theirstatus: Student

GA/TA

Faculty

Staff

3. Whatwasdonetoyouthatyoufeelwasunfair? (checkallthatapply):

DeniedFairGrade
DeniedAccesstoProgram
DeniedAccommodation
DeniedEqualPay
DeniedEqualTreatment
FailedtoHire
DeniedTraining
DeniedPromotion
LaidYouOff
TerminatedYou
ForcedYourRetirement/Resignation
Subjectedyoutoahostileworkenvironment
Other:

14

4.Wereyougivenareason(s)forwhatwasdonetoyou? Ifso,whatreason(s)?

5. Whatdoyouthinkistherealreason(s)? Discrimination* becauseof..

Creed/ReligiousBelief
NationalOrigin/Ancestry
Pregnancy
OpposedDiscrimination
Other(explain):

Gender
Age
Race/Color
Physical/MentalCondition/Disability
Marital Status
Sexual Orientation
Sexual Harassment

*Note: If you dont believe the reason was discrimination, please inform the Affirmative Action/EEO
Specialist.

6.Disabilitycases:

Whatisthenatureofyourdisability?

7.Didyouaskforanaccommodation?Yes No

Ifso,towhom?_

Whatwastheaccommodationsought?

8.Original(first)dateofdiscrimination:

9.Mostrecentdateofdiscrimination:

10.Haveyoufiledacomplaintwithanyotheragency,court,ordept.regardingthismatter?Yes No
Ifso,where?

11.Describeeverythingthathappenedtoyouthatyoufeelwasdiscriminatory.Includeeachevent,the
date(s),namesand titlesof everyoneinvolved.
Attachadditionalpagesif necessary.

12.Didyoucomplain?Yes No

Ifso,towhom?

13.Whendidyoucomplain?

14. Wasanyoneelsetreatedthesamewaythatyouwere?

Name

JobTitle

Race/Ethnicity

Age

Gender

15. Didanyonewitnessthetreatmentthatyouweresubjectedto?

Name

JobTitle

TelephoneNo.

Whatdidtheywitness?

16.Areyouaunionmember?Yes No Ifso,didyoufileagrievancewithyourunion?

CSEA

PEF

UUP

Council#82

GSEU

NYSCOBA

17.Whatisyourcurrentsalary?

18. Arethereanydocumentsthatcansupportyourcase? Ifso,whatarethey,anddoyouhavethem?

19.Whathaveyoulostasaresultofwhathappenedtoyou?(salary,benefits,etc.)

20.Whatreasonableremedyareyoulookingfor?

I affirm that I have read the above allegation(s) and that it is (they are) true to the best of my
knowledge.TheOfficeofDiversityandAffirmativeActionandtheComplainantshallagreetokeepall
informationgathered relative to allegations of discriminationin confidence to the extent practicable or
allowablebylaw. However,withtheconsentoftheComplainant,theOfficeofDiversityandAffirmative
ActionmayproviderelevantinformationtotheappropriateUniversitystaffwhennecessary.

I have been advised that it is a violationof State and Federal statutes to retaliateagainstan individual
becausetheyhavefiledadiscriminationcomplaint. IfIamsubjectedtoanyadverseactionthatIfeelmay
beretaliatory,IwillpromptlyreportsuchtotheOfficeofDiversityandAffirmativeAction.

I have been further advised that the filing of an internal complaint with the Office of Diversity and
AffirmativeActionisnotawaiverofmyrighttofileaformalcomplaintofunlawfuldiscriminationwith
theNewYorkStateDivisionofHumanRights,theEqualEmploymentOpportunityCommission(EEOC),
theFederalcourts,ortheStatecourts.

Inaddition,Iamadvisedthatthefilingofaninternalcomplaintdoesnotstopthestatuteoflimitations
for filing external complaints with EEOC, the NYS Division of Human Rights, litigation, or any other
agency hearing such complaints. I am aware that should I choose to file a verified complaint with an
outsideagency,suchacomplaintmustbefiledwithEEOCwithin180daysof the allegedincident,and
withtheStateDivisionofHumanRightswithin365daysoftheallegedincident.2

Date

ComplainantsSignature

Revised 1/04

ForOfficeUse:

Please note that this policy and the information contained in it does not constitute legal advice. If you require legal
advice, consult an attorney.

16

Forma De Reclamo

Numero de caso _

La Universidad de Stony Brook, La oficina de Diversidad y Accin Afirmativa

Fo rmu l ario d e Info rmaci n y Reclamo

Nombre:

Fecha:_

Direccin:

Numero de telefono(dia):_

Numero de telefono (noche):_

Podemos contactarlo en el trabajo?

Empleado del estado

No

Estudiante (no graduado) Estudiante (graduado)

1. Por favor indique su:

Fecha de nacimento:

Sexo:

Religin:

Raza/Etnica:

Estado civil:

Ttulo de trabajo:

Fecha que fue empleado:

Grado de educacin completado:

Departamento en que trabaja:

Nombre de supervisor y el ttulo:

2. Nombre(s) y ttulo de la persona(s) que presuntamente a discriminado contra usted.

Ellos son: Estudiante Asistente graduado/asistente de professor

Facultad

3. Que le hicieron que usted cree fue injusto? ( marke todo que aplique):

Negado grado justo

Negado acceso a programs
Negado comodidad
Negado tratamiento justo
Negado empleo
Negado pago justo
Negado entrenamiento
Negado Promocion
Lo han despedido
Han terminado su empleo
Forcado su reginacin/ jubilacin
Lo han sometido a un ambiente de trabajo hostil
Otra razn:

4. Le a dado usted razn para justificar lo que le han hecho.? Cul fue la razn?

5. Cul cree usted que es la razon verdadera? Discriminacin a causa de ..

Su creencia religiosa/credo
Nacion de origen/ascendencia
Embarazo
Discriminacin Opuesta
Otra razn (explique):

Gnero
Raza/Color
Estado civil
Acoso sexual

Edad
Condicion fsica/mental/discapacidad
Orentacon sexual

*Nota:

Si usted no cree que la razn es discriminacin, por favor informe al especialista de accin
afirmativa.

6. Caso de impedimentos: Que es su impedimento?

7. Pido usted ajustes razonables? S No Cual fue la ajuste razonable ?

8. La fecha del primero incidente de discriminacin:

9. La fecha del incidente de discriminacin mas reciente :

10. Ha llenado otro reclamacion con otra agencia, corte, o departamento en referencia de este mismo caso?

11. Describa todo lo que ocuro que usted siente fue discriminacin. Incluya todo evento, fecha, nombres
y ttulos de todos los participantes :

12. Puso una reclamacion?

A quien?

13. Cuando puso la reclamacion?

14. Alguien mas fue tratado de la misma manera que usted fue tratado?
Nombre
Ttulo
Raza/ Etnica Edad

Gnero

15. Alguien fue testigo de este tratamiento al que usted fue sujeto ?

Nombre

Ttulo

Numbero de Telefono

De que fueron testigo?

16. Es miembro de una unin? S No Lleno un reclamo con la unin? S No

CSEA PEF UUP Council 82 GSEU NYCOBA

17. Cual es su salario?

18. Tiene documentos que apoye su caso? S No Que son y los tiene usted ?

18

19.

Que a perdido como resultado de lo que le a pasado? ( salario, benecifios, etc.)

20. Que remedio razonable busca?

Yo afirmo que a leido los alegatos arriba y que a mi mejor conocimento todo es cierto. La Oficina de Diversidad y
Accin Afirmativa y el reclamante estan de acuerdo que todo la informacin reunida es relativa a los alegatos de
discriminacin y es en confianza. Sin embargo, con el consentimiento del reclamante la Oficina de Diversidad y
Accin Afimativa, puede dar informacin relativa al reclamo al personal de la Universidad cuando sea necessario.

Estoy aconsejado que es una infraccin Estatal y Federal tomar represalias contra un individuo por la razn que ellos
han llenado una reclamo de discriminacin. Si yo soy subjetido a una accin (medidas) adversa que yo siento es
represalia, yo le informare a la Oficina de Diversidad y Accin Afirmativa.
Me han aconsejado que al llenar una reclamacin interna con la Oficina de Diversidad y Accin Afimativa no
renuncio mi derecho a llenar un reclamo formal de descriminacin ilegal con la Division de Derechos Humanos del
el Estado de Nueva York, La Comision de Igualdad de Oportunidades de Empleo, corte federal, o corte de estado.
Adems, me han aconsejado que llenando un reclamo interno no afecta el estatutes de limitacion exponido dentro de
la ley federal y del estado. Estoy enterado que si lleno una reclamo verificada con una agencia externa, tengo 180
dias dentro la ocurencia del presunto incidente para llenar un reclamo con el EEOC y tengo 365 dias del presunto
incident para llenar un reclamo con La Division de los Derechos Humanos en el Estado de Nueva York.

Fecha

Firma de el reclamante

Para uso de la oficina:

* Observe por favor que esta pliza y la informacin contenida no constitute asesoramiento leagal. Si usted requiere
asesoramiento legal, consulte a un abogado.
Revisado 3/04

AppendixC
ComplaintProcessatAGlance

Intake
Process

Mediation/
Resolution

Investigation

Review
Records

Fact Finding
Meetings

Interview
Witnesses

Determination

Unsubstantiated
No Probable
Cause

Substantiated
Probable
Cause

20