• Middlesex College

  • 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?*

  • Accused can be classified as:*
  • Incident Date*
     - -

  • Involved Parties/Witnesses

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

  • Gender

  • Role
  • Format: (000) 000-0000.
  • Were there other involved parties/witnesses?
  • Party/Witness #2: Gender

  • Party/Witness #2: Role
  • Format: (000) 000-0000.
  • Party/Witness #3: Gender

  • Party/Witness #3: Role
  • Format: (000) 000-0000.
  • Party/Witness #4: Gender

  • Party/Witness #4: Role
  • Format: (000) 000-0000.

  • Incident Information

  • Has the incident been reported to local law enforcement?
  • With which local agencies?*

  • Would you like to speak with a member of the campus counseling staff regarding this incident?
  • Would the victim/survivor like to a request a College investigation regarding the reported incident?

  • Supporting Documentation

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

  • Browse Files
    Cancelof
  • Should be Empty: