Discrimination, Discriminatory Harassment, Sexual Misconduct, or Retaliation Complaint

Background Information

Your full name and 900#:

Your position/title:

Your phone number:

Your email address:

Email address must be of a valid format.

Your physical address:

Date of incident(Required):

This field is required.

Time of incident:

Location of incident(Required):

This field is required.

Specific location:

Involved Parties

Name or Organization

Select Role

900 #

DOB (YYYY-MM-DD)

Phone number

Email address

Address

Questions

Please provide the information below, with as much detail as possible.

Describe the nature of the discrimination of harassment to which you believe you were subjected:(Required) This field is required.

Provide the date on which the alleged conduct first occurred:(Required) This field is required.

Provide the date on which the alleged conduct most recently occurred:(Required) This field is required.

Provide the names of all relevant witnesses (please specify whether employee, student, or other):(Required) This field is required.

Provide the name of person(s) who engaged in the alleged conduct toward you:(Required) This field is required.

Describe in detail the specific incident(s) that you experienced:(Required) This field is required.

What harm, physical or otherwise, if any, have you experienced?(Required) This field is required.

I request that the following action be taken: This field is required.

I have filed a complaint/ grievance with another agency:(Required) This field is required.

If you answered "yes" to previous question, please provide the name of the agency This field is required.

Thank you for submitting your complaint. By submitting this complaint, you acknowledge and understand the following: 1. I have the right to be free of retaliation for filing this complaint. I agree to report any conduct, which I believe is motivated by retaliation for filing this complaint. I understand, that if this statement contains accusations that I know are false, I may be subject to disciplinary action within the University, and/ or external legal action from those I have falsely accused. 2. The Office of Equal Opportunity will reveal investigative information to others only on a need to know basis or as required by law. The individual(s) I am accusing of misconduct or wrongdoing will be given a copy of this complaint to have an opportunity to respond to it. 3. I have received a copy of the Discrimination, Harassment, Sexual Misconduct, Title IX Violations, and Retaliation policy of Metropolitan State University of Denver. I may have other rights under law about which I may contact a legal advisor. 4. I understand that the Office of Equal Opportunity is a neutral fact finding office that investigates complaints to determine whether violations of the University's Discrimination, Harassment, Sexual Misconduct, Title IX Violations, and Retaliation policy have occurred, and does not represent me or advocate for me. I ATTEST THAT THE STATEMENTS I MADE IN THIS COMPLAINT ARE TRUE AND ACCURATE, AND THAT I HAVE READ AND UNDERSTAND THE STATEMENTS MADE HEREIN. Your Signature and Date below(Required) This field is required.

Supporting Documentation

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Email me a copy of this report

Background Information

Involved Parties

Questions

Supporting Documentation

Submission