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Discrimination, Harassment & Retaliation Misconduct Reporting Form

Please note that submissions using this form might not be reviewed outside of normal business hours. If there is an immediate risk to health or safety, please call 911 or University Police at 657-278-2515.


The CSU prohibits discrimination, harassment and retaliation, sexual misconduct, dating and domestic violence, and stalking. Such behavior violates University policy and may also violate state or federal law. This form should be used to report an incident involving discrimination, harassment, or retaliation. For students: California State University Executive Order 1097 provides definitions and a detailed explanation of the policy and complaint process. For employees and third parties: California State University Executive Order 1096 provides definitions and a detailed explanation of the policy and complaint process.


Incidents involving gender-based discrimination, gender-based harassment, sexual misconduct, stalking, dating and domestic violence and/or a violation of University policy regarding consensual relationships should be directed to the Title IX Coordinator.


Please note this form is not confidential. Those seeking to discuss a concern while maintaining confidence to the greatest extent possible should contact Blair Miles to discuss options at 657-278-4933 or bmiles@fullerton.edu.


Background Information
 



 












 

Involved Parties/Witnesses

Please list the individuals involved (excluding yourself). Include as many of the listed fields as you provide.


Information About the Incident
 




Supporting Documentation

Please note there is a 15MB file limit. If the file you wish to upload exceeds 15MB, please contact Blair Miles to discuss options at 657-278-4933 or bmiles@fullerton.edu.