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Sexual Harassment Complaint Form

Sexual Harassment Complaint Form

New York State Labor Law requires all employers to adopt a sexual harassment prevention policy that includes a complaint form to report alleged incidents of sexual harassment. 

If you believe that you have been subjected to sexual harassment, you are encouraged to complete this form and submit it to Jerilee Gulino, Assistant Superintendent for Human Resources and Title IX Coordinator, (585) 637-1912. Forms may be submitted electronically below, by email, by USPS mail to Jerilee Gulino, 40 Allen St. Brockport, NY 14420 or in person. You will not be retaliated against for filing a complaint.

If you are more comfortable reporting verbally or in another manner, your employer should complete this form, provide you with a copy and follow its sexual harassment prevention policy by investigating the claims as outlined at the end of this form.

For additional resources, visit the New York State website