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S&T - Equity & Title IX - Incident Reporting Form


Please report any incidents of discrimination you have experienced or observed. In addition, please tell us about any incidents you have experienced or observed that impede our campus from being a welcoming and safe environment. We appreciate your willingness to report. The more information you can provide, the better the University is able to conduct a thorough investigation and make an informed decision on the incident.

We will take into consideration the impacted party’s wishes on how they would like the incident to be handled, however, there may be times when the University’s obligation to effectively address discrimination may conflict with the impacted party’s wishes.

Please note that submissions using this form may not be reviewed outside of normal business hours. If there is immediate risk to health or safety, please contact Campus Safety at (573) 341-4300.

If you do not feel comfortable utilizing the online form, you may make a report in person by visiting our offices at:

Equity and Title IX
900 Innovation Drive
Suite 500
Rolla, MO 65409

Reporter Information

We respect and appreciate an individual’s decision to report concerning behavior. We encourage all reporters to share their personal information so that a University investigator can follow up, when necessary, to confirm our understand of the information contained in the report provided. This is especially true if you were the individual who has experienced discrimination and harassment.

Mandated Reporters have an expectation of disclosing their individual contact information.

Non-Mandated Reporters have the right to remain anonymous on this form but please be aware that the more details we possess, the better our ability to conduct a thorough investigation. To remain anonymous, simply leave out your identifying information. Without this information, the form will be submitted anonymously.

 
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Please provide your legal name here. There are options below for Preferred Name and Pronouns.
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If you are unsure of the incident date, please enter the date you were informed of the incident.
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Please specify if incident occured in multiple locations.

Those Involved in the Incident

Please enter as much information as you can for any of the individuals involved in the matter being reported. Be sure to include yourself if you were directly involved in the matter. If you are unsure of the identity of an individual, please list them as Unknown.

When selecting the role a person has in the matter being reported, please use the following definitions:

  • Complainant - refers to the person alleged to have been impacted by discrimination, harassment or sexual misconduct in violation of the University’s Anti-Discrimination Policies.
  • Respondent - refers to the individual alleged to have violated the University’s Anti-Discrimination Policies.
  • Witness - refers to an individual with first-hand knowledge about matters relevant to the alleged incident.
  • Other - refers to any individual not otherwise specified (examples include: concerned bystander, parent, visitor etc.)
Involved party 1

Incident Details Regarding the Concerning Matter

Please provide as much information as possible. Greater detail will provide University Investigators the best possibility to conduct a thorough investigation. Please focus on the behaviors that directly relate to the alleged discriminatory behavior such as discrimination, harassment, sexual misconduct, dating/domestic violence, or stalking.

Dates, times, and locations are important elements to include in the report.

Do you identify as a Mandated Reporter as defined in the Collected Rules and Regulations? A Mandated Reporter is defined as an employee of the University who has become aware of discrimination or harassment, including sexual harassment as defined in CRRs 600.010 or 600.020, regardless of whether the recipient of the behavior is a student, employee, volunteer, or visitor of the University. Employees with a legal obligation or Privilege of Confidentiality are not considered Mandated Reporters, including health care providers and counselors.(Required)
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If you have chosen to remain anonymous, please understand that this could impact our ability to conduct an investigation. We would like your permission to contact you for additional information and details. Please indicate below the mode of communication you would prefer. Please be advised: Missouri University of Science and Technology reserves the right to pursue any complaint alleging discrimination or harassment under the University's Anti-Discrimination policies.
You must make at least one selection.
Please indicate other departments that have been notified (check all that apply):
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SUPPORTING DOCUMENTATION

Photos, video, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission