Harassment Complaint Resolution Acknowledgement

Name of Respondent:

Name of Complainant:

Although my signature on this document does not constitute an admission of guilt, I do acknowledge that the complainant perceived my actions as being offensive. My signature on this form is my agreement that I will cease-and-desist the actions that are perceived as being offensive.

_________________________________        ____________________
Signature of respondent                                       Date

I am satisfied my complaint has been acknowledged and that actions taken by the respondent are satisfactory to me.

_________________________________        ____________________ 
Signature of complainant                                      Date