Marital Status at time of harassment:

Number of children:

Physical condition:

We all deserve to be treated with respect.

Appearance:

Height:

Education:

Yearly Personal income:

Yearly Family Income:

Is harassment related to a harasser's status?

General job history -- was this your first job, how long had you worked there, had you just been promoted, etc.

Were you fired when you complained?

Were you able to get another job?

Was the matter handled satisfactorily by your employer?

What was your position at the time of the harassment?

What kind of organizations did you belong to at the time, i.e., church, civic, feminist, service.

Narrative of sexual harassment experience

Name (optional):

Address:

E-mail address:

Is harassment related to physical appearance?

Age:

.Marital Status at time of harassment:

Number of children:

Physical condition:

Appearance:

Height:

Are harassers without other interests?

Education:

Yearly Personal income:

Yearly Family Income:

Community standing (Organizations belonged to, religion, volunteer activities, etc.)

Job or occupation:

Number of people supervising:

Looking for some common bonds between harassers as well as between victims

Name of Harasser:

Name of Business:

Address of Business:

Kind of Business

Have you experienced health problems since the sexual harassment began?  Explain.

Have you experienced health problems since you initiated complaints regarding your sexual harassment?  Explain

Comments and Suggestions:

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