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Discrimination/Sexual Misconduct Report


BEFORE YOU BEGIN

If this is an emergency that involves an imminent risk of harm to self or others

  • Contact Public Safety at 516-877-3511, or Dial '5' from any campus phone;
  • Call the Garden City Police Department at (516) 465-4100, or;
  • Call 911

Take this action prior to filling out this referral form. Referrals are reviewed during normal business hours and may not be monitored after hours, on weekends, or during official University holidays. This form is NOT designed to report emergencies.


You should authenticate your credentials by logging into the Adelphi University portal to access this form.

If you have any questions about which form to use, please contact the Community Concerns and Resolution Office at 516-877-6864 or by email at occr@adelphi.edu 

Definitions of terms:

Discrimination is different treatment based on membership in a protected class.
Protected classes include:

Harassment is repeated, unwelcome, threatening, and/or intimidating behavior directed at an individual or group based on their actual or perceived membership in or association with a protected class.

Retaliation is intentional action taken by an accused or allied third party that harms or attempts to harm a reporting party, a witness, or a supporting individual as reprisal for filing a complaint of discrimination, serving as a witness, or support in an investigation of discrimination.  

Background Information

This form is designed to provide Adelphi University students, staff, faculty, vendors, or visitors with an easy method to report specific information related to an alleged incident(s) of discrimination, harassment (including sexual misconduct), or retaliation.

You are not required to complete the entire form in order for the allegation to be submitted. The University will use the information provided to begin an investigation, which may include contacting the complainant, respondent, and/or any potential witnesses. However, if the report does not contain specific information, the University’s investigation and response may be limited.

 
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Identify the relationship between the parties (Complainant-Accused)
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Involved Parties

Please list all of the involved parties in this incident, including yourself.

Involved party 1

Questions

Please complete the following questions to assist in the processing of your report.

If you are filing a discrimination or harassment report, please indicate the protected status(es) that are part of the alleged behavior.(Required)
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What remedy are you seeking? Please note that your requested remedy may not be granted, due to law or other university policies.(Required)
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Please acknowledge the statement below: By submitting this form, the information I have provided is true and accurate to the best of my knowledge.(Required)
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Supporting Documentation

Please use this section to upload any supporting information. (any file type is accepted) 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission