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Title IX: Harassment, Discrimination, Sexual Misconduct, and Retaliation Online Complaint Form

This form is designed to provide students, employees, faculty, vendors, visitors, or others with an online method to report specific information related to an alleged incident(s) of discrimination, harassment (including sexual misconduct), or retaliation.

You are not required to complete the entire form in order for the complaint to be submitted. Although anonymous complaints are permitted, doing so may limit the College’s ability to investigate and respond to a complaint. Mesalands Community College will use the information provided to begin an investigation, which may include contacting the complainant, respondent, and/or any potential witnesses. The College’s ability to respond is improved based on the quantity and quality of information provided.

While providing details is essential to investigating your complaint, please be advised that some or all of the information you provide in this section may be shared with the person(s) you are accusing. You may supplement this description later if you wish to share additional details.

Background Information

If you wish to identify yourself, please fill in the information listed below.

If the person completing this form is the victim, you may choose to identify yourself or not. If you are a third party complainant who is not the victim, include the victim.







Additional Party #1




Additional Party #2




Additional Party #3





AgeDisabilityGenetic PredispositionMarital StatusNationality/AncestryPregnancy/ParentingRace/EthnicityReligionSex/GenderSexual OrientationVeteran Status


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