Discrimination and Harassment Complaint

Background Information

Your full name:

Your position/title:

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Please enter: Student, Staff, Faculty or Other

Your phone number:

Your email address:

Email address must be of a valid format.

Your physical address:

Date of incident(Required):

This field is required.

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Policy requires the compliant to be filed within 60 days of the incident.

Time of incident:

Location of incident(Required):

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Specific location:

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Please provide a room number if appropriate

Involved Parties

Please identify all persons involved in this incident. Victim, accused and witnesses.

Name or Organization

Select Gender

Select Role

ID Number (if known)

DOB (YYYY-MM-DD) (if known)

Phone number (if known)

Email address (if known)

Address (if known)

Questions

Please describe, in detail, the specific events and/or behaviors that are the subject of the complaint.(Required) This field is required.

What is the basis of the alleged discrimination/harassment?(Required) This field is required.

Describe the alleged discrimination/harassment based on the type of discrimination/harassment (age, gender; disability, etc).(Required) This field is required.

What corrective action do you believe would address your complaint?(Required) This field is required.

Supporting Documentation

If you have any supporting documents please submit them with this complaint. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Email me a copy of this report

Background Information

Involved Parties

Questions

Supporting Documentation

Submission