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, a member of People Operations will contact you.

If you do not wish to complete the Complaint Form, please contact People Operations who can assist you to fill out the form on your behalf.

People Operations
people.operations@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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