Gender-Based Misconduct Report Form

This form should be used to report an incident involving an alleged violation of the Columbia University Gender-Based Misconduct Policies (including sexual harassment, sexual assault, gender-based harassment, intimate partner violence, and stalking). This report form can be utilized by students wishing to file a report on their own behalf or by anyone wishing to file a report on behalf of a Columbia University, Barnard or Teachers College student.

Please note that submissions using this form may not be reviewed outside of normal business hours.
If there is immediate risk to health or safety, please contact Columbia Public Safety at 212-854-5555.

Please note that all faculty members, staff members, and administrators, with the exception of those working in a confidential capacity (e.g., counselors, rape crisis advocates, medical providers, and clergy) are expected to report any disclosures that involve allegations of gender-based misconduct.

Background Information

Your full name:

Your position/title:

Your phone number:

Your email address:

Your physical address:

* Nature of this report:

* Date of incident:

must be formatted YYYY-MM-DD

Time of incident:

* Location of incident:

Specific location:

Involved Parties/Witnesses

Please list the individuals involved (excluding yourself), including as many of the listed fields as you can provide. Pre-authorized users may click here to lookup individuals

	Name or Organization			UNI (all lowercase)
	DOB (YYYY-MM-DD)	Phone number	Email address	Hall/Address

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. Maximum 12 megabytes per file
Attachments require time to upload, so please be patient after you click to submit this report.

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Gender-Based Misconduct Report Form

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