Appendix M EEO-MD-110

SAMPLE TITLE PAGE

                            Title Page

                       (Agency Letterhead)

                                   )
(COMPLAINANT)                   :
(Complainant's Address)         :
(Complainant's City, State, Zip):    
                                   )
                    Complainant :
                                   )
                                   )
and                                )
                                   )
                                   )         AGENCY CASE NO.___
(AGENCY HEAD)                   :
(Title)                         :
(Agency Name)                      )         OTHER NUMBERS
(Agency Address                    )
(P.O. Box)                         )
(City, State, Zip)                 )
                    Agency      :


                       INVESTIGATIVE REPORT

This page was last modified on November 8, 1999.

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