Mass Cultural Council Complaint Form

Complete this form to file a complaint of Racism, Discrimination, Sexual Harassment, Domestic Violence/Sexual Assault/Stalking, Workplace Violence, Retaliation and/or Bullying.

Once you have submitted the complaint form, the Senior Director of Business Operations/CFO will contact you.

If you do not wish to complete the Complaint Form, please contact the Senior Director of Business Operations/CFO who can assist you to fill out the form on your behalf.

Cathy Cheng-Anderson
Senior Director of Business Operations/CFO
Direct line: 617.858.2732
Confidential Fax: 978.313.0360
Catherine.cheng-anderson@mass.gov

1. Are you the complainant or are you submitting on someone's behalf? *This question is required.

2. If you are filing a complaint on behalf of someone, please provide your contact details *This question is required.

First Name

Last Name

Title

Organization Name

Street Address

City

State

Zip

Email Address

Mobile Phone

2. Are you a Mass Cultural Council Employee? *This question is required.

2. Please list complainant name and contact Information *This question is required.

First Name

Last Name

Title

Organization Name

Street Address

City

State

Zip

Email Address

Mobile Phone

3. Are you a Mass Cultural Council Employee

4. Please include the name and title of the individual/s the complaint is filed against. Please provide name/s and contact information. *This question is required.

6. Please provide a detailed summary of your complaint.

7. Date of first incident This question requires a valid date format of MM/DD/YYYY.

calendar

8. Date of last or most recent incident This question requires a valid date format of MM/DD/YYYY.

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9. To whom has this been reported to.

10. Please list to whom you have reported the incident/s to. Please list name, and contact information.

10. Attachment (optional)

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