21st LD Code of Conduct Complaint Request Form

Code of Conduct Complaint Request


Use this form to request a review of a situation you feel may be a violation of the 21st LD Democratic organization’s Code of Conduct policy.


Your request will be reviewed by the Executive Board and if deemed credible for further investigation will be assigned for processing according to the Code of Conduct Complaint Procedure.

Refer to the 21dems.org website for document references on the Code
of Conduct and Procedure.


Accuser must be available to meet with investigatory committee when requested to do so.
Accuser can enter arbitration.
A 60- day timeline for the completion of the claim is expected.

  • Required
    Alleged Victim Accuser Name *
    The Accused Name *
    3/11/2020 Code of Conduct Complaint Request
    https://docs.google.com/forms/d/1aBNZ9FAfW7h0qdHDBZ0cgRIokbsHFMQWRPA4r9DORck/edit 2/3
    4. Example: January 7, 2019
    5.Example: 8:30 AM
    6.Files submitted:
    Date of the incident *
    Time of the incident *
    Location where the incident occurred (whether physical location in
    person, or online source such as email) *
    Exact and short description of the claim (to concisely summarize or
    identify the specific Violation of the 21st LD Dems Code of Conduct
    (bullying/harassment) policy *
    Documentation to support the claim against the Accused (emails, texts,
    potential witness names, etc.)
    3/11/2020 Code of Conduct Complaint Request
    https://docs.google.com/forms/d/1aBNZ9FAfW7h0qdHDBZ0cgRIokbsHFMQWRPA4r9DORck/edit 3/3

    Example: January 7, 2019
    11.Files submitted:
    This content is neither created nor endorsed by Google.
    Full statement from Claimant describing the nature of the claim, the
    ‘what happened’ ie facts of the situation, and how Claimant was
    affected
    Date of Claim submission
    Signature of Accuser( upload file) *