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Anonymous Report of Discrimination
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Office of Student Conduct
Anonymous Report of Discrimination
Status of the person experiencing the discrimination
Faculty
Staff/Administrator
Student
Student Employee
Applicant
Other
I would like to identify myself or receive help from the Office of Accountability, Education and Compliance
State
Florida
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Race of Complainant
Hispanic or Latino
White
Black or African American
Native Hawaiian or Pacific Islander
Asian
Two or More Races
Basis of Complaint (check all that apply)
Race
Disability
Retaliation
National Origin
Veteran Status
Age
Color
Religion
Genetic Information
Pregnancy
Marital Status
Other
Accused Perpetrator/Respondent status
Faculty
Staff/Administrator
Student
Student Employee
Applicant
Other
Respondent First Name
Respondent Last Name
Position/Title
Department
Phone number
Gender of Accused Perpetrator / Respondent
Female
Male
Trans Identifying
Gender Queer - Gender Non-Conforming
Different Identity
Prefer Not to Answer
Race of Respondent
Hispanic or Latino
White
Black or African American
Native Hawaiian or Pacific Islander
Asian
Two or More Races
Date/Time of Incident
Location where discrimination occurred
Physical Location
Digital Environment
Screenshot
Please select a file
Delete file
Statement of discriminatory, harassing, or retaliatory conduct
Harm Suffered
i.e., Termination, Resignation, Suspension, Demotion, Written Reprimand, Lower Class Grade, Dropped the Class, Emotional Distress, Poor Performance Evaluation, etc.)
Is anyone else aware of the incident?
Comparatives - Different Treatment
List of person(s) who were treated more favorably than you under similar circumstances
Comparatives - Similar Treatment
List any person(s) who may have experienced a similar incident from the respondent
Would you like someone from any of these offices to follow up with you?
Student Counseling Center
Campus Ministries
Campus Safety and Security
Student Health Center
Student Solutions Center