Employee & Third Party Complaint Forms

Executive Order 1096, Revised 10-5-2016 was established to provide employees who are not eligible to file a discrimination, harassment or retaliation complaint or grievance under a collective bargaining agreement, the opportunity to file formal complaints alleging violations of CSU Systemwide policies against discrimination, harassment or retaliation. The Executive Order is also available to employees in bargaining units who collective bargaining agreements have incorporated the CSU systemwide complaint procedure for such purposes.

If you would like to submit your concern, please complete the Complaint Form for Discrimination/Harassment/Retaliation Complaints, located as an Attachment on the left navigation bar of Executive Order 1096, Revised 10-5-2016 (first click on the signed PDF version) on the California State University website. After completing:

  • Save the form to your device, or print it
  • Submit either electronically or in person
  • Submit to one of the following DHR Administrators:

Alex Najera, Associate Vice President for Human Resources and Co-Chief Diversity Officer, CSUSB, Sierra Hall, Room 110, (909) 537-5138, alex.najera@csusb.edu.
OR
Seval Yildirim, Associate Provost for Faculty Affairs and Development, CSUSB, Administration, Room 101, (909) 537-5029, seval.yildirim@csusb.edu

 

OR if the allegations involve Sex Discrimination and/or Sexual Harassment, except Sexual Violence which cannot be informally resolved, you may submit your concern to CSUSB's Title IX Coordinator using the File a Report Form, or you may send an email (TitleIX@csusb.edu), call us (909-537-5669) or come to our office (Santos Manuel Student Union, Room 103).