Office of Equal Opportunity & Affirmative Action

This form may be used to report incidents of discrimination and harassment. This includes sex-based harassment, sexual assault, and other forms of sexual misconduct that you believe are in violation of University of Utah policy. This form may also be used to report issues of violation of the university’s youth protection policies. Reporting DOES NOT constitute submitting a complaint. The affected party will be contacted to be given options for submitting a complaint.

DO NOT USE THIS FORM TO REPORT AN IMMEDIATE THREAT. IF YOU HAVE AN EMERGENCY OR IMMEDIATE THREAT OR SAFETY CONCERN, CALL 911 OR UNIVERSITY POLICE DEPARTMENT AT 801-585-COPS (2677).

You may also call us at 801-581-8365 or email us at oeo@utah.edu.

Can I fill out this form anonymously?

Yes, however, the University may be limited in the amount of follow up that can be provided if there is insufficient information.

Who can use this form?

Anyone wishing to communicate to the university on your own behalf or on behalf of another person. All employees - except those who are specifically named as confidential employees -- are mandatory reporters and must report allegations of discrimination, including sexual harassment, sexual assault and other forms of sexual misconduct.

What happens after I fill out this form?

Information on this form is sent to the Office of Equal Opportunity and Affirmative Action (OEO/AA). If you provide contact information, an employee of the OEO/AA will follow up with you. If you are filling out this form on behalf of someone else and you provide contact information for that person, the OEO/AA will also follow up with them.

Is the information on this form confidential?

No. Students, staff or faculty who would like to speak with someone confidentially should contact the Victim Advocates (801) 581-7776. Students may contact the Counseling Center (801) 581-6826. Information provided on this form is private and will be shared only with people who need to know.

What if someone retaliates against me for reporting?

University policy prohibits retaliation for engaging in activities protected under the University’s Nondiscrimination Policy. This means that no person may intimidate, threaten, coerce, or discriminate against any individual for the purpose of interfering with any right or privilege protected under this Policy or because the individual has made a report or complaint, testified, assisted, or participated or refused to participate in any manner in an investigation proceeding or hearing under this Policy or its associated Regulations. Please contact the OEO/AA if you believe you have experienced retaliation for having filed a report.

Are you reporting Discrimination, Retaliation, or Sexual Misconduct?

What type of Discrimination are you reporting? Select all that apply

What type of Sexual Misconduct are you reporting? Select all that apply

When did this incident take place? Please be as specific as you can.

Date

Time

hh:mm am/pm

If you don't have a specific date or time, please describe when the incident occurred.

Where did this incident take place? Please be as specific as you can.

If you don't have a specific location, please describe the location where the incident occurred.

Incident Description - Please provide as many details as you can regarding the incident, and any other information that could is relevant to this issue.

Please share the name(s) of the person engaging in the misbehavior (Respondent), if you feel comfortable

Add Respondent?

YesNoThe person who engaged in the misconduct

Respondent Information (The person who engaged in the misconduct)

Respondent's first name. Enter "unknown" if this is not known.

First name of the person who engaged in the misconduct

Respondent's last name. Enter "unknown" if this is not known.

Last name of the person who engaged in the misconduct

Respondent uNID

Are you reporting on behalf of someone else? (If you report on someone else’s behalf and provide information about that individual, the OEO/AA will follow up with them to provide information and offer resources.)

YesNo

Complainant Information (the person who experienced the misconduct)

Complainant's first name. Enter "unknown" if this is not known.

First Name of the person who experienced the misconduct

Complainant's last name. Enter "unknown" if this is not known.

Last name of the person who experienced the misconduct

Complainant uNID

Complainant Email

Remain Anonymous?

YesNo

The University may be limited in its ability to follow up without sufficient information.

Contact Information

Are you a student, faculty member, staff, or other?

First Name

Last Name

Reporter uNID

Your email or phone number are optional. However, the University may be limited in its ability to follow up without an email or phone number.

Phone

Preferred Contact Method

University of Utah Office of Equal Opportunity

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