REPORT SEXUAL HARASSMENT/VIOLENCE

Sex Discrimination and Sex-Based Harassment Report Form

This report documents alleged incidents of sex discrimination and sex-based harassment
(including quid pro quo sexual harassment, hostile environment harassment, sexual assault, domestic violence, dating violence, stalking, and sexual exploitation).

Filing this report does not constitute filing a formal complaint.

EMERGENCIES

If there is an immediate risk to health or safety, please call Campus Safety at 618-222-5555 (ext.5555) or 9-1-1.

Call Public Safety

or

DIAL 911

Important Filing Information

*This report may be submitted anonymously. Please note that choosing to make an anonymous report can significantly limit the ability of the College to respond.

**This information is not mandatory but is valuable in allowing the college to look into the concern.

**Reporter’s Full Name

First Last

Reporter’s position/title: (student, Instructor, etc..)

Role at the College

Contact information

** Phone Number

INCIDENT INFORMATION

Date of Incident*

Time of Incident

Campus*

Building

Location*

Other*

Incident Information

Any additional incident information that you feel is important for the reviewing team to know.*

Involved Parties:

Please list the parties involved and provide as much information as you have available to you.

“Complainant”: means a person who is allege to have been subject to conduct constitute sex discrimination.

“Respondent”: means a person who is alleged to have violated the College’s prohibition on sex discrimination.

Please list other involved parties*

Name	Role	Student ID Number	Phone Number

CAPTCHA

REPORT SEXUAL HARASSMENT/VIOLENCE

IMMEDIATE THREATS

or

DIAL 911

Sex Discrimination and Sex-Based Harassment Report Form

Filing this report does not constitute filing a formal complaint.

EMERGENCIES

or

DIAL 911

Important Filing Information

Involved Parties:

East St
Louis

Fire
Science

PSOP
Campus

Scott Air
Force Base

SW Justice &
Workforce Dev

Other
Campus