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Report a Problem
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Problem Description
- Select -
Sexual harassment/misconduct, Title IX, or gender discrimination
Discrimination, harassment, or ADA
Equal employment, affirmative action, or harassment prevention education
Date of incident
If applicable and known. Otherwise, leave blank and explain below.
Incident description
Location of incident
Person Reporting
Name
Email
Phone
Status
Student
Employee
Other…
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Relationship to parties involved
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responsibilities of Academic or Administrative Officers
.
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if you don’t know if you are a mandatory reporter.
Person Harmed
Name
Email
Phone
Status
Student
Employee
Other…
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Is the person aware this report is being made?
Yes
No
Additional Person Harmed
?
Name
Email
Phone
Status
Student
Employee
Other…
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Is the person aware this report is being made?
Yes
No
Person Accused
Name
Email
Phone
Status
Student
Employee
Other…
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Is the person aware this report is being made?
Yes
No
Additional Person Accused
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Name
Email
Phone
Status
Student
Employee
Other…
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Is the person aware this report is being made?
Yes
No
Law Enforcement Involvement
Has law enforcement been notified?
Yes
No
What agency?
Was an arrest made?
Yes
No
Unknown
Are the police investigating?
Yes
No
Unknown
Name
Email
Telephone
Please provide a summary of your concern
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