Inquiry and Resolution Form

Reporter's Information

Please provide your information below. This will allow the University to reach you for follow up.

Your full name:

Field of Study:

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Your cell phone number:

Your email address:

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Your physical address:

Date of incident(Required):

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What day did the incident occur?

Time of incident:

Location of incident(Required):

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Involved Parties

Name or Department

Gender

Email address

Information Gathering

Please answer the questions below to the best of your ability.

What is your inquiry? Please be specific. Include the following: the individual or office against whom the inquiry is brought, a description of the specific action or behavior resulting in this report, date, time (or period of time), location of the incident, and any individuals who witnessed any part of the dispute.(Required) This field is required.

What have you done to informally resolve the concern?(Required) This field is required.

What do you feel needs to happen to resolve this inquiry?(Required) This field is required.

Have you notified any other staff, faculty or department about this inquiry? Who? When? What was their reaction?(Required) This field is required.

Are you a Graduate Student or Undergraduate Student?(Required) This field is required.

Supporting Documentation

Please attach any documents you have that may be of importance to this grievance. 5GB maximum total size.
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Reporter's Information

Involved Parties

Information Gathering

Supporting Documentation

Submission