Report It! - Western New Mexico University

If you or someone you know is in immediate danger, please call 911

What are you reporting? *

Please be more specific (select all that applies) *

Sex/Gender-Based Discrimination

Sex/Gender-Based Harassment

Sexual Exploitation

Sexual Assault

Domestic Violence

Dating Violence

Stalking

Retaliation

OtherOther

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If you believe that you have experienced or witnessed a sexual harassment/assault, you are encouraged to fill out this complaint form. However, depending on the information you provide, the university may investigate without your formal or written consent. The university will take action based on the information provided by you. The information submitted with this form is confidential and abides with HIPAA and FERPA requirements. If you need help during this process, please see the available options here.

Name (Complainant) *

Date of Complaint *

Your Relationship to WNMU *

I am reporting an incident that affected:

someone

Provide their name(s) or description *

The victim is: *

Name(s) or Description of who you believe committed the alleged act(s): *

If this incident occurred in class, provide CRN if possible

The individual(s) committed the alleged act(s) is/are:

Employee

Student

Authorized/Volunteer

Guest/Visitor

Please describe the alleged incident(s), and when and where it/they occurred. *

Please identify all individuals with knowledge of the conduct about which you are complaining. *

What would you consider an appropriate resolution to your report? *

Additional Documentation – Upload File

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Disclosure

To investigate your complaint, it may be necessary to interview you, the respondent(s), and any witness with knowledge of the allegations or defenses. The statement and the information that you are providing may be attributed to you and could be included in any investigative reports that are prepared. Further, it may be necessary to include you as a witness in any hearing that may occur due to this report.

Contact Information

Email *

Phone Number *

Alternative Phone Number

Street Address

City

State

Zip

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Note: If you are unable to submit this report, please email your report to CivilRights@wnmu.edu or Titleix@wnmu.edu. Thank you.

If you are human, leave this field blank.

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Report an incident of discrimination/harassment or sexual misconduct that occurred to you, that you witnessed or that was reported to you.

If you or someone you know is in immediate danger, please call 911

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