Name:*Email: Status:*StudentFacultyStaffCampus VisitorVendorPhone (###)###-####*Against whom are you filing this complaint? Please list the name(s) of the individual(s) you believe violated this policy.*Type of Complaint:*DiscriminationHarassment (including sexual misconduct)RetaliationWhat happened that made you decide to contact this office?*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. When and where did the incident(s) occur,and it is still ongoing? Please give date(s) and time(s) and location(s).Please list any witnesses/observers to the incident(s) and include contact information, if known.What response did you make when the incident(s) occurred or afterwards?Please add any additional information that supports your complaint.What remedy are you seeking?By submitting this form, I certify that the information I have provided is true and accurate to the best of my knowledge. EmailThis field is for validation purposes and should be left unchanged.