Reporting Party [person making the complaint]

Is reporting party the alleged victim
Request to remain anonymous

Basic of Complaint

Check all that apply. Basis should be discrimination or harassment based on protected category or a complaint related to a form of Sexual Misconduct.
Basis of complaint

Reported to Police

Reported to police
If Yes, which police department?

Respondent [person alleged to have violated the Policy]

Respondent status

Details of Complaint

Describe each incident of harassment, discrimination, sexual misconduct, or retaliation separately. Please be as detailed as possible, giving names, dates and places, include phone numbers and addresses if possible. Use additional pages if needed


List those witnesses you believe have information about your complaint. Include complete information for each witness listed. If the Reporting Party is not the alleged victim, please identify the alleged victim as a witness below. Add additional pages if necessary.
Witness #1
Witness1 Status
Witness #2
Witness2 Status
Witness #3
Witness3 Status

Supporting Materials/Documents

List and produce any written materials or other documents you believe may help in investigating your complaint. Please include social media or text communications if available. Items may be physically provided or electronically provided.

Unlimited number of files can be uploaded to this field.
5 MB limit.
Allowed types: pdf, doc, docx.

Additional Information

Have you previously reported or otherwise complained about this or related acts of harassment, discrimination or retaliation to a College supervisor or official? If so, please identify the individual to whom you made the report, the date you made the report and the resolution.

 By checking this box, I affirm that I have read the above information and it is true to the best of my knowledge and belief.