Job title at time of alleged discrimination: Name and title of immediate supervisor: If an applicant, date you applied for job: Job applied for: 4. Date(s) discriminatory action(s) took place: Page 2.The Broward County EEO Complaint Form is designed for individuals to report incidents of discrimination or harassment in the workplace. Broward College has put together the following references about the steps involved in applying for a student visa. A charge of discrimination can be completed through our online system after you submit an online inquiry and we interview you. The information requested on this form is required for Federal Equal Employment. Opportunity (EEO) reporting requirements only. Family Court Records Request Form Downloads, Self Service Forms, E-Filing. Contact Information: Central Courthouse, Brenda D. Forman, Clerk of Court. Please Note: If you are an international student with an F1 visa, do not submit the above Opt-Out Credit form.