NWU Human Rights Committee complaint form | Human Rights at the NWU | Services | NWU

If more than one person would like to send a complaint to us, each person must complete a separate form.

Personal Details

Full names *

Surname *

Preferred name *

Title *

Who are you? *

If other, please scecify *

Employee/Student number

Workplace/Campus *

If other, please scecify *

Gender *

Race *

If other, please scecify *

Contact details

Email address *

Cellphone number *

Office number

Home number

Fax number

Complaint

Please describe exactly what happened. Include all the information, but be as brief as possible. *

On what date did this happen? *

Month

Day

Year

Is is still happening? *

Where did it happen? *

Do you know which right(s) in the Bill of Rights was/were violated or is/are being violated? *

If you know, please state the right(s). *

Do you know the full name(s), surname(s) of person(s), the association or organisation who violated these rights? *

If yes, please provide such. *

Do you have the contact details of those mentioned in the above question, if known? *

If yes, please provide such.

Email address

Cellphone number

Office number

Home number

If the name(s) of the person(s) who violated your human rights are unknown, please provide as much detail as possible about him/her/them, alternatively provide all the information known to you about the person(s) *

Did anybody see or hear what happened? (Only people who actually saw or heard what happened first hand – witnesses.) *

If yes, please provide the details:

Full names *

Surname *

Cellphone number *

Email address

Office number

Has this matter been reported to anyone else?

If yes, to whom? *

Were any steps taken by the person(s), the association or organisation (to whom/which this matter was reported) to resolve this matter? *

If yes, please describe the steps *

What outcome do you propose or expect from this complaint? *

Please indicate what you would like to achieve with this complaint and the relief sought.

Would you be willing to testify against the person(s), the association or organisation that violated your rights? *

Please be informed that should you not be willing to testify, the NWU Human Rights Committee may not be able to make a recommendation regarding formal steps to be taken against the person(s), the association or organisation involved. Such recommendations can include mediation and disciplinary action.

Do you need an interpreter when attending any proceedings, investigations or possible hearings? *

If yes, please indicate the language *

If other, please specify *

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