University of Southern Mississippi Logo

Sexual Harassment and Retaliation Online Complaint Form


Prior to completing this form, please review the USM Interim Sexual Harassment Policy And Procedures.

This form is designed to provide students, employees, faculty, vendors, visitors, or others with an on-line method to report specific information related to an alleged incident(s) of sexual harassment), or retaliation as provided for by the USM Interim Sexual Harassment Policy And Procedures and Title IX, the federal law that prohibits discrimination based on sex in education programs or activities that receive Federal financial assistance.

You are not required to complete the entire form in order for the complaint to be submitted. The institution will use the information provided to look into an allegation, which may include contacting the complainant, respondent, and/or any potential witnesses. However, if the report does not contain specific information, the institution's investigation and response may be limited.

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, include the victim

 
Enable additional features by logging in.
Email address must be of a valid format.
This field is required.
This field is required.
Learn more
For Urgent help, contact UPD at 911
This field is required.
Learn more
Be as specific as possible
This field is required.
Learn more
Room or Office Number

Involved Parties

Please identify all person(s) involved in this incident.

Involved party 1

Questions

While providing details is essential to investigating your complaint, please be advised that some or all of the information you provide in this section may be shared with the person(s) you are accusing. You may supplement this description later if you wish to share additional details.

Please indicate the status of the victim of the alleged behavior.(Required)
You must make at least one selection.
Please indicate the status of the perpetrator of the alleged behavior.(Required)
You must make at least one selection.
This field is required.
This field is required.
Have you taken any action to stop the behavior?(Required)
This field is required.
This field is required.
This field is required.
This field is required.
This field is required.
This field is required.

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.

Submission