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Harassment/Discrimination Complaint Form


Please Note: This reporting form will time-out for security purposes within 20 minutes from opening the page.
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This is a secure reporting format, accessible only to the Title IX Coordinator designee. If you need more information about reporting, contact us at TitleIXCoordinator@everettcc.edu or at 425.388.9271.

If the Title IX Coordinator is a subject of this report please click here.

This form may be used by students, employees, vendors, visitors or other concerned parties to report specific information related to an alleged incident(s) of sexual violence and/or gender discrimination, including harassment, sexual misconduct and retaliation. Sexual misconduct includes, but is not limited to, sexual harassment, sexual violence, sexual exploitation, intimate partner/dating violence and stalking.

The college will investigate allegations of harassment/discrimination that happen off campus when the behavior impacts the campus such that an individual's employment, education, and/or access to college programs, activities and opportunities are limited because of the reported behavior.

If this is an emergency, please dial 911. Contacting the police does not require you to pursue legal action.

General Information - Items denoted with an asterisk are required

The college will use the information provided below to address the complaint, which often includes beginning an investigation and contacting the complainant, respondent and/or any potential witnesses. Although you may report anonymously, if the report does not contain specific information, know that the college's investigation and response may be limited.

 
Email address must be of a valid format.
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ex: GW Hall, rm 166 or 19th & Broadway

Involved Parties

Please list the individuals involved, including yourself, the person you are concerned about, the person you are complaining about, any witnesses, and/or anyone else you believe can provide information about the incident(s) reported.

Involved party 1

Reason(s) for Report

What is the relationship of the Person Being Reported to Everett Community College?(Required)
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What is your role/relationship to Everett Community College?(Required)
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What is the relationship of the Person Being Reported to the victim?(Required)
You must make at least one selection.
Per your best estimation, please indicate the reason(s) you believe the victim has been treated unfairly or otherwise violated. This form does not address general complaints related to conflicts in the academic or work environment that are not directly related to the following categories:(Required)
You must make at least one selection.
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Do you believe you have experienced retaliation as a result of speaking to anyone about this incident or making a prior report?
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Was a police report filed in this matter?(Required)
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Have you discussed this complaint with anyone at the college?(Required)
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What is your preferred method of contact?(Required)
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FALSE CLAIM: The college prohibits the filing of a false claim. Filing a false claim knowing that it is false will result in an immediate investigation and appropriate action. By checking the box below and submitting this form, you certify that the information you have provided is true and accurate to the best of your knowledge.(Required)
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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.

Submission