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Discrimination and/or Harassment Reporting Form

Do NOT use this form to report events presenting an immediate threat to health or safety. If you require emergency assistance, dial 911.

Complete the form below to report an incident of discrimination, harassment and/or bias based on protected class. This form does not constitute filing a criminal complaint with the police. To file an official police report, please contact Public Safety and Police Services at 906-487-2216.

You may report ANONYMOUSLY by omitting information in any field. Only fields marked with (required) are required to be complete for the form to be able to be submitted.

This form serves as official notice to Michigan Tech and authorizes Equal Opportunity Compliance staff to initiate a preliminary investigation into the information and allegations contained within the report. Please note: anonymous reports may be difficult to investigate. Allegations may not be determined to violate university policy; however, we can provide appropriate and reasonable support and assistance.

For additional information or questions, please contact:
Equal Opportunity Compliance
310 Administration Building
906-487-3310
Office Hours: Monday-Friday - Fall and Spring Semester 8:00am-5:00pm and Summer Semester 8:00am-4:00pm
Equal Opportunity Complaince Email Address - eocompliance@mtu.edu
Equal Opportunity Website - https://www.mtu.edu/equity/

Question: What happens when I submit this form?
Answer: The information will be reviewed by Equal Opportunity Compliance staff to first assess whether there are any potential safety concerns for the individual(s) or the University that need to be addressed in a timely manner. If possible, the Complainant (victim) would be notified about these actions.

Question: Will I be contacted?
Answer: After the report is assessed for safety concerns, Equal Opportunity Compliance staff will reach out to the Complainant by email (if provided and/or other contact information provided) to acknowledge and follow up on the report, provide options for support and resources, and share information regarding options and next steps. Witnesses and third-party reporters may not be contacted due to privacy concerns. See mtu.edu/equity for more information about the process.

Background Information

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Your full name:

Your phone number:

Your email address:

Email address must be of a valid format.

Your physical address:

University Affliation:Pick One(Required):

This field is required.

Date of incident(Required):

This field is required.

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Please use approximate date or today's date if exact date of incident is unknown.

Time of incident:

Location of incident(Required):

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Specific location:

Involved Parties

Name or Organization

Select Role

Phone number (if known)

Email address (if known)

Address (if known)

Questions

Supporting Documentation

Photos, video, email, 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.

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