Sexual Misconduct Online Complaint Form

First Name*

Last Name*

EMPL ID

Phone

BMCC Email

Personal Email

Preferred method of contact

Phone
BMCC Email
Personal Email
Other

Other

Preferred pronouns

For example: he/she/them etc.

Check this box if you wish to remain anonymous

Anonymous

Are you a:*

Current BMCC student
Former BMCC student
BMCC Employee
Former BMCC Employee
BMCC Faculty Member
Former BMCC Faculty Member
Other

Other

What type of unlawful discrimination/harassment are you reporting?*

Check all that apply

Other

Location of incident:

On campus
Off campus
Other

Other

Date(s) of incident(s):

Approximate time of incident(s)

Hour :

Minute

Name of Respondent(s)

A Respondent is the person you are filing the complaint against.

Is the Respondent a:

BMCC student
Other CUNY student
BMCC Employee
BMCC Faculty Member
Other

Other

Please describe your complaint in detail.*

Please include names, locations, description of incidents, and the dates involved. If relevant, please include the class name/section and/or department name.

Has this incident been reported to law enforcement?

Yes
No

Has this incident been reported to BMCC’s Public Safety?

Yes
No

Is there any additional information you wish to provide?

Please add any relevant documents or attachments:

Drop files here or

Max. file size: 20 MB.

By submitting this online complaint form, I affirm that the above allegations are true to the best of my knowledge, information, and belief.*

Acknowledged

When you click the “submit” button, the information entered above will be sent to the Office of Compliance and Diversity for review.

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