Discrimination, Retaliation, and/or Anti-Harassment Report Form

Background Information

Your information (optional, but prefered)

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Your full name:

Your position/title:

Your phone number:

Your email address:

Email address must be of a valid format.

Person accused is a:(Required):

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Select the choice that best fits (respondent or person accused).

Date of incident(Required):

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Time of incident:

Location of incident(Required):

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Specific location:

List All Involved Parties (INCLUDE YOURSELF!)

FULL NAME or ORG

Select Role

Questions

The next section will ask you questions about the involved parties and the categories for your report. Use this link regarding protected classes to understand what category to use: [CLICK HERE]. See definitions for retaliation, harassment, and discrimination in the Policy [CLICK HERE]. Remember that some complaints that involve sex discrimination may fall under the Title IX and Sex Discrimination Policy. To file a report under that policy, [CLICK HERE].

Refer to the policy to see definitions on harassment, retaliation, and discrimination (see link above). Please indicate the type of report you are submitting (check all that may apply):(Required)

Harassment (based on protected class - including written or digital - *some reports may transfer to Title IX) Retaliation (intimidation, threats, and other adverse action based on protected class) Discrimination (based on protected class. See aforementioned list linked above) Title VI (discrimination based on race, color, or national origin) Other (please specify in section below)

You must make at least one selection.

If you selected "Other" above. Please explain below. If not applicable, put N/A.(Required) This field is required.

Gender of the alleged COMPLAINANT. (The person with a complaint of an alleged violation of the policy)(Required) This field is required.

Gender of the alleged RESPONDENT. (The person who will respond to the complaint of an alleged violation of the policy)(Required) This field is required.

Are you aware of any witnesses? If so, did you list them in the "Involved" section above?(Required)

Yes, I listed the names of those I believe to be witnesses No, there were no witnesses to my knowledge Unknown. At this time, I am unsure if there are or were any witnesses Other. I will explain more in the narrative section

This field is required.

To the best of your knowledge, was substance use of any kind present during the incident and/or was a factor of this incident. For example, did the complainant (victim or person with complaint of allegation) or the respondent (accused or person responding to the complaint) consume alcohol and/or drugs whether legal or illegal in connection with this incident?(Required)

Yes, alcohol only Yes, drugs only Yes, alcohol and drugs No substances were used in connection with this incident Unknown Other. I will explain further in the narrative section below

This field is required.

NARRATIVE: Describe the incident in detail, include the name of the alleged complainant(s), respondent(s) and any potential witnesses or others involved. If you prefer to write a separate document, please indicate that you will upload a document in this box and submit that document in the "Supporting Documentation" area below. (Pro Tip: Grab the corner of the narrative box to elongate the box for more space to write).(Required) This field is required.

The Sewanee Police Department (SPD) are also here as a resource to make involved parties aware of their criminal options if they choose to file a police report. Although this report may be copied to SPD, submission of this reporting form does not constitute a police report. To file a police report, you must speak directly to SPD. Please indicate below if you wish for the Sewanee Police Department to contact you. Declining to speak with SPD now, does not prevent you from speaking to SPD at a later time.(Required)

Yes, I would like to be contacted by the Sewanee Police Department to talk about my options to pursue a criminal report I do not wish to speak to the Sewanee Police Department at this time. I am aware that I can speak to SPD at any time I am reporting on behalf of someone else

This field is required.

CONFIDENTIALITY: Confidentiality is an important value; however, when necessary, the University has an obligation to interview individuals and/or to investigate organizations and events that might violate University policy and create an unsafe environment.* All reports of this nature are directed to the University's Senior Director of EEOT and staff. Reports may also be copied to the Dean of Students office for undergraduate students, Human Resources for staff, the Dean or Director where applicable for graduate student programs or faculty, and the Sewanee Police Department.(Required)

YES

You must make at least one selection.

CONFIDENTIALITY AND SUPPORT: I understand that if I desire to speak with a confidential resource, I can contact the University Wellness Center (if I am an undergraduate student) at 931-598-1270 between the hours of 8:00 am and 4:30 pm (closed at noon for lunch) or 931-598-1700 after normal business hours. The University Wellness Center has medical and counseling services available during normal business hours. I understand that I may also speak to the ordained clergy in All Saints' Chapel, if I am an employee, grad student, or undergraduate student. I can call 931-598-1274 to speak to ordained clergy. I know that the information that I disclose must be disclosed while clergy are acting in their professional capacity. I know that there is no mandatory reporting under this form. Mandatory reporting is only under the Title IX policy.(Required)

YES

You must make at least one selection.

REPORTING RETALIATION, HARASSMENT, AND/OR DISCRIMINATION: I acknowledge that The University of the South prohibits discrimination in employment, admission of students, and administration of its education programs or activities on the basis of one or more protected classes, including sex and disability. Any student, employee, or applicant for admission or employment may initiate a grievance for sex discrimination, which is prohibited by Title IX of the Education Amendments of 1972, as amended. Any student or employee may initiate a grievance for disability discrimination using this form, which is prohibited by the Rehabilitation Act of 1973 (section 504), as amended. Retaliation of any type is strictly prohibited. Retaliation can be broadly defined, but includes intimidation, threats, harassment, and other adverse action threatened or taken against any reporter or other persons participating in the grievance and conduct processes. Retaliation should generally be reported promptly to the Title IX Coordinator for sex discrimination or the Senior Director of EEOT for all other forms of retaliation, harassment, and discrimination based on protected class. Individuals also have the option to file a criminal complaint directly to the Sewanee Police Department or other local police. I understand that submission of this form does not constitute a criminal complaint or police report.(Required)

YES

You must make at least one selection.

I understand that this report may go to the University officials listed at the top of this form and I pledge that the information submitted is accurate to the best of my knowledge. I am also aware that submission of this form does NOT constitute the submission of a formal complaint. I know that I must reach out to the Senior Director of EEOT to submit a formal complaint.(Required)

YES

You must make at least one selection.

I understand that my report must be based on one or more protected classes. If my report does not meet this and other standards under the Policy, it may be dismissed and forwarded to the appropriate conduct office (i.e. Student Conduct, Human Resources, etc.) for further review under those policies.(Required)

YES

You must make at least one selection.

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.

Email me a copy of this report

Background Information

List All Involved Parties (INCLUDE YOURSELF!)

Questions

Supporting Documentation

Submission