Civil Rights Complaint Form

Background Information

Your full name:

Your position/title:

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(ie- Instructor, Staff, Student)

Your phone number:

Your email address:

Email address must be of a valid format.

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Please know all communication will begin with e-mail. Check your CCD e-mail regularly.

Date of incident(Required):

This field is required.

Time of incident:

Location of incident(Required):

This field is required.

Specific location:

Involved Parties

Please include as much information as possible regarding all persons who were involved in or may have information regarding the incident being reported.

Name or Organization

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ID Number (if known)

DOB (YYYY-MM-DD)

Phone number

Email address

Address

Incident Report

Please be as detailed as possible in your description of incident(s) that occurred. You'll have an opportunity to attach all supporting documents at the end of this report.

Please describe the incident in detail.(Required) This field is required.

We highly encourage attempting to resolve complaints informally. Would you be interested in attempting this process?(Required)

Yes No

This field is required.

Please describe your requested remedy for this complaint.(Required) This field is required.

Please read and insert your initials to confirm this statement: I am willing to cooperate fully in the investigation of my complaint and provide whatever evidence the Community College of Denver deems relevant. I affirm that the information I am providing is true and correct to the best of my knowledge. I understand that my statements and the information that I am providing may be attributed to me and could be included in any investigation reports that are prepared. I also understand that this investigation is confidential and for me to disclose any information that I have obtained during the course of this investigation could interfere with the investigation. Further, I understand that discussing this investigation with Non-College Officials could expose me to civil liability under current defamation law. I also understand that if I do not fully cooperate, decisions will be made based on the best information available to CCD. Please check this box to indicate your acknowledgement.(Required) This field is required.

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 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

Incident Report

Supporting Documentation

Submission