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Complaint Form for Harassment, Discrimination, Sexual Misconduct, and Retaliation


This form may be used by anyone (faculty, staff, students other concerned parties) to report concerns pertaining to possible violations of the University Of West Georgia's Anti-Discrimination Policy and/or Sexual Misconduct Policy, including retaliatory actions.

At the University of West Georgia, we use the term sexual misconduct for sexual harassment, sexual assault/sexual violence, sexual exploitation, intimate partner violence, and stalking.

This is a secure report format accessible only to the appropriate university administrators. These reports are monitored on university business days from 8 AM to 5 PM. If you desire immediate assistance, please contact the University Police at 678.839.6000. Contacting the police does not require you to pursue legal action, unless you want to do so. University Police can connect students to a University Counselor 24 hours a day, 7 days a week. Students in need of a sexual assault exam can also make contact with the University’s Medical Doctor 24 hours a day, 7 days a week through the University Police.

Please note that although you have the option to make this report anonymous, doing so may limit the University's options for response.

Complainant Information (Person making the report)

If you wish to submit this information anonymously, it will limit the ability of administrators to address the incident. While anonymous reports are useful for tracking patterns and assessing campus safety, more information and participation on the part of the person making the report allows the university to promptly and thoroughly investigate.

**If you are not the victim/survivor please provide that person's name in the "Involved Parties" section below.**

 
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Your personal cell phone number is preferable
Email address must be of a valid format.
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Who is the complainant against?
This field is required.
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If multiple dates, please select the date of the first occurrence.
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Please give an approximate time, if you are not able to remember the exact time
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If a UWG residential facility, please state the name of the hall or Greek Village house letter.

Please list the names of person(s) you are making the report about

Under most circumstances the respondent (the person about whom you are making this report) will not be contacted until a University official contacts you (the complainant) to explain the process of addressing this report, including your options. In extreme situations, the University may have to act quickly on a report that points to an immediate threat to others on campus. If you submit your contact information every reasonable effort will be made to keep you informed.

Involved party 1

Questions

What is your role at the University of West Georgia?(Required)
You must make at least one selection.
On what basis do you believe that you have been discriminated against? (check one or more items) If this is a report of sexual misconduct (sexual harassment, sexual assault, domestic or dating violence, stalking), please select "Sexual Misconduct"(Required)
You must make at least one selection.
This field is required.
This field is required.
This field is required.
Have you taken any action to stop the behavior? Please note this question is being asked to assess the context of the incident(s).(Required)
You must make at least one selection.
This field is required.
This field is required.
Do you believe you have experienced retaliation as a result of speaking to anyone about this incident or making a prior report?(Required)
This field is required.
This field is required.
This field is required.
This field is required.

Supporting Documentation

Do you have any documents (emails, texts, screen shots of social media conversations, photos) or other materials that will help us understand your complaint? If yes, please upload these documents. If you prefer, you may submit documents and/or other materials in person upon meeting with a University official. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission