<Form No. 1> Report of Complaint
<Complaint No.><>
<Date of Receipt><>
<Receptionist><>
Report of Complaint 

1. Information on Complainant

<Name><><Gender><><Category><Undergraduate Student □ Graduate Student □ Faculty □ Staff □ External Party □ Other □>
<Department><><Student ID / Employee ID (Faculty ID) / Position><>
<Mobile No.><><E-mail><>
<Address><>
<Offended person’s information, in case that the complainant is a 3rd party>
<Name><><Gender><><Category><Undergraduate Student □ Graduate Student □ Faculty □ Staff □ External Party □ Other □>
<Department><><Student ID / Employee ID (Faculty ID) / Position><>
<Mobile No.><><E-mail><>
<Address><><Relation to the offended person><>

※ Have you obtained the offended person's consent to submit this form?  Yes□   No□
2. Information on Respondent
<Name><><Gender><><Category><Undergraduate Student □ Graduate Student □ Faculty □ Staff □ External Party □ Other □>
<Department><><Student ID / Employee ID (Faculty ID) / Position><>
<Mobile No.>