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Academics » Academic Affairs and Office of Provost » Title IX and Civil Rights » Complaint Form

Complaint Form

You may report anonymously, however, please understand that NU is significantly impaired in the ability to investigate anonymous reports.

Complainant Information

Name

First Last

Email

Phone

Job Title / Student Status

Select Preferred Communication Method

Phone

Email

In Person

Who is your complaint about?(Required)

Title/Student Status(Required)

Phone

Email

Relationship to you:

Supervisor

Subordinate

Co-Worker

Intimate Partner

Acquaintance

Other

Please describe what happened and how it is affecting you and your work/life. Additional information (i.e. text messages, images) can be gathered at a later date.(Required)

Date(s) incident(s) occurred:(Required)

Is it continuing?

Yes

No

Please list the name and contact information of any witnesses or individuals who may have information related to your complaint:(Required)

(Optional) Have you previously complained or provided information (verbal or written) about related incidents? If yes, when and to whom did you complain or provide information?

Required Information(Required)

By checking this box you understand that, if you have retained legal counsel and would like us to work with them, please provide their contact information.

Required Information(Required)

By checking this box, you affirm that all of the information submitted is true to the best of your ability.

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海角大神, N.Y. 14109

1.800.778.3450

Canvas