Name of Person Making Report *

First Name

Last Name

Phone

(###)

###

####

Which option best describes this form submission?

REPORT: I experienced misconduct by a student, faculty member, or staff member, and I am requesting assistance/intervention (including possible disciplinary action) from the institution.

RESOURCE REQUEST ONLY: I experienced misconduct and am seeking information/resources only. I am NOT asking the institution to intervene or initiate other action at this time.

THIRD PARTY REPORT: I am not the affected/harmed party, but I am reporting misconduct on behalf of someone else.

Other/Unsure

What is the nature of the alleged misconduct? (please select all that apply) *

Discrimination (based on a protected status)

Discriminatory Harassment, Bullying, or Other Misconduct (based on a protected status)

Failure to Accommodate for Disability

Non-Consensual Sexual Penetration (rape)

Non-Consensual Sexual Contact (fondling/groping)

Sexual Harassment

Intimate Partner and/or Domestic Violence

Sexual Exploitation

Stalking

Retaliation (equity-based)

Do you feel this behavior happened because of your (or the affected party's) membership in any of the following protected classes? (if yes, please select all that apply; if reporting retaliation, please select "retaliation" at end of list)

No/Not Applicable

Age

Ancestry

Color

Disability

Gender Expression

Marital Status

Military/Veteran Status

National or Ethnic Origin

Pregnancy or Parental Status

Race

Religion

Sex/Gender (discrimination)

Sex (sexual misconduct)

Sexual Orientation

Other/I don't know

Retaliation