Sexual Harassment Complaints

Sexual Harassment Complaints
Reporting Party Information

You may choose to complete the form anonymously, though the College may be limited in its abilities to fully investigate and resolve the reported concern.
Who is completing this report?*

StudentStaff or FacultyWitnessConcerned EmployeeOther
Accused can be classified as:*

StudentStaffFacultyVendor or Third PartyNot Affiliated with Middlesex College
Incident Date*

MonthDayYear
Incident Location
Involved Parties/Witnesses

Please include as much information as you have available regarding other individuals who were involved or may have witnessed the indicent.
Name

First NameLast Name
Gender

FemaleMaleTransgenderOther
Role

Victim/SurvivorAllegedWitnessReporting Party (if different from victim)
ID Number
Phone Number
###-###-####
Email
email@example.com
Were there other involved parties/witnesses?

YesNo
How many other parties/witnesses were involved?*
Max. 3
Party/Witness #2: Name

First NameLast Name
Party/Witness #2: Gender

FemaleMaleTransgenderOther
Party/Witness #2: Role

Victim/SurvivorAllegedWitnessReporting Party (if different from victim)
Party/Witness #2: ID Number
Party/Witness #2: Phone Number
###-###-####
Party/Witness #2: Email
email@example.com
Party/Witness #3: Name

First NameLast Name
Party/Witness #3: Gender

FemaleMaleTransgenderOther
Party/Witness #3: Role

Victim/SurvivorAllegedWitnessReporting Party (if different from victim)
Party/Witness #3: ID Number
Party/Witness #3: Phone Number
###-###-####
Party/Witness #3: Email
email@example.com
Party/Witness #4: Name

First NameLast Name
Party/Witness #4: Gender

FemaleMaleTransgenderOther
Party/Witness #4: Role

Victim/SurvivorAllegedWitnessReporting Party (if different from victim)
Party/Witness #4: ID Number
Party/Witness #4: Phone Number
###-###-####
Party/Witness #4: Email
email@example.com
Incident Information
Description*
Please provide a narrative of the incident, including as much detail (direct quotes, specific locations, etc.) as you are comfortable providing.
Has the incident been reported to local law enforcement?

YesNo
With which local agencies?*

Edison Police DepartmentMiddlesex CountyOther
Would you like to speak with a member of the campus counseling staff regarding this incident?

YesNoUnsure at this time
Would the victim/survivor like to a request a College investigation regarding the reported incident?

YesNoUnsure at this time
Supporting Documentation

Upload any videos, photos/screenshots of text messages, emails, or other files you would like to include with the incident description.
File(s)

Browse Files

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Sexual Harassment Complaints

Reporting Party Information

Involved Parties/Witnesses

Incident Information

Supporting Documentation