Discrimination Complaint Reporting Form

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If you are reporting an emergency or an imminent threat, please contact University Police at 607-587-3999 or 911 immediately.

This form is to be used by students and employees to file a complaint of discrimination based on Race, Color, Religion, Sex, National Origin, Sexual Orientation, Veteran's Status, Age, Disability, Marital or Parental Status, or Sexual Harassment.

Question #5 below asks how you would like your complaint processed under the college's grievance procedure.

Background Information
Alleged Person(s)
Please indicate below who your complaint is against and whether they are an employee or student:
Complaint Details & Action Requested
Please answer the following questions:
Honesty Statement & Report Submission