Node Complaint Form Node Complaint Form Explore More Equal Opportunity and Title IX Compliance Non-discrimination and Harassment ADA and Reasonable Accommodations Title IX Sexual Misconduct Resources Training and Education File a Complaint Complaint Form Meet Equal Opportunity and Title IX Compliance Staff Reporting Party [person making the complaint] Reporting party name Reporting party title Is reporting party the alleged victim Yes No Department Daytime phone Campus address Home address Home phone Cell phone Email Status Student Faculty Staff Other… Enter other… Request to remain anonymous Yes No Preferred contact method 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 Age Dating Violence Disability Domestic Violence Ethnicity Gender Identity Genetic information National Origin Pregnancy Race Religion Retaliation for DEC complaint/ investigation Sex/Gender Sexual Assault Sexual Battery Sexual Exploitation Sexual Harassment Sexual Orientation Stalking Veteran Status Other Reported to Police Reported to police Yes No If Yes, which police department? GGCPD Gwinnett PD Other Police Department Enter other Police Department Respondent [person alleged to have violated the Policy] Respondent name Respondent title Respondent Department Respondent daytime phone Respondent campus address Respondent home address Respondent home phone Respondent cell phone Respondent email Respondent status Student Faculty Staff Other… Enter other… Details of Complaint Date of incident Time of incident Location of incident 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 Description of incident Witnesses 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 Name Witness1 Title Witness1 Address Witness1 Work phone Witness1 Home phone Witness1 Cell phone Witness1 Email Witness1 Status Student Faculty Staff Other… Enter other… What information can witness provide? Witness #2 Witness2 Name Witness2 Title Witness2 Address Witness2 Work phone Witness2 Home phone Witness2 Cell phone Witness2 Email Witness2 Status Student Faculty Staff Other… Enter other… What information can witness provide? Witness #3 Witness3 Name Witness3 Title Witness3 Address Witness3 Work phone Witness3 Home phone Witness3 Cell phone Witness3 Email Witness3 Status Student Faculty Staff Other… Enter other… What information can witness provide? 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. Written materials or other documents Upload/attach supplemental documents 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. Additional report What would resolve this complaint? What type of outcome are you seeking? I agree to the terms of service. 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.
Reporting Party [person making the complaint] Reporting party name Reporting party title Is reporting party the alleged victim Yes No Department Daytime phone Campus address Home address Home phone Cell phone Email Status Student Faculty Staff Other… Enter other… Request to remain anonymous Yes No Preferred contact method 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 Age Dating Violence Disability Domestic Violence Ethnicity Gender Identity Genetic information National Origin Pregnancy Race Religion Retaliation for DEC complaint/ investigation Sex/Gender Sexual Assault Sexual Battery Sexual Exploitation Sexual Harassment Sexual Orientation Stalking Veteran Status Other Reported to Police Reported to police Yes No If Yes, which police department? GGCPD Gwinnett PD Other Police Department Enter other Police Department Respondent [person alleged to have violated the Policy] Respondent name Respondent title Respondent Department Respondent daytime phone Respondent campus address Respondent home address Respondent home phone Respondent cell phone Respondent email Respondent status Student Faculty Staff Other… Enter other… Details of Complaint Date of incident Time of incident Location of incident 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 Description of incident Witnesses 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 Name Witness1 Title Witness1 Address Witness1 Work phone Witness1 Home phone Witness1 Cell phone Witness1 Email Witness1 Status Student Faculty Staff Other… Enter other… What information can witness provide? Witness #2 Witness2 Name Witness2 Title Witness2 Address Witness2 Work phone Witness2 Home phone Witness2 Cell phone Witness2 Email Witness2 Status Student Faculty Staff Other… Enter other… What information can witness provide? Witness #3 Witness3 Name Witness3 Title Witness3 Address Witness3 Work phone Witness3 Home phone Witness3 Cell phone Witness3 Email Witness3 Status Student Faculty Staff Other… Enter other… What information can witness provide? 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. Written materials or other documents Upload/attach supplemental documents 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. Additional report What would resolve this complaint? What type of outcome are you seeking? I agree to the terms of service. 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.
