Harassment, Discrimination, Title IX, and Retaliation On-Line Complaint Form

Background Information

If you wish to identify yourself, please fill in the information listed below.

If the person completing this form is the victim, you may choose to identify yourself or not. If you are a third party complainant who is not the victim, please include the victim's name. If you do not know the SID (Student Identification number) leave it blank and that information can be found later by a University Official.

Your full name:

Your position/title:

Your phone number:

Your email address:

Email address must be of a valid format.

Your physical address:

Type of Complaint(Required):

This field is required.

Date of incident(Required):

This field is required.

Time of incident:

Location of incident(Required):

This field is required.

Specific location:

Involved Parties

Please identify the person(s) whom the complaint is made.

Name or Organization

Gender

Role

ID Number

Phone number

Email address

Hall/Address

Questions

Supporting Documentation

Please add any additional documents that support your 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