ucsc policies

sex offense policy
appendix g: sexual harassement complaint form

You do not have to use this form to receive assistance

If you believe you have been sexually assaulted or harassed by any member of the University community or while participating in a University sponsored activity, you are encouraged to bring it to the attention of the Title IX/ Sexual Harassment Officer (SHO), and/or other University official.  This form is to be used for reporting to the Title IX/SHO.  If you would like to initiate a criminal investigation of a sexual assault, call the UCSC Police Department, 9-1-1 or (831)459-2231, as soon as possible.

The Title IX/SHO is available to provide you with answers to questions you may have about the process and your options, advice and/or referrals.  You are not obligated to use your name; however, should you want disciplinary action taken, if appropriate, in response to your allegation(s), your name is essential to the process.  If you feel strongly about confidentiality, the Title IX/SHO can put the person “on notice” and attempt to stop the behavior through an educational process on the law and policy on sexual harassment and the inappropriateness of the person’s conduct.   Whatever your decision, the Title IX/SHO or any other University official is available to assist you in stopping the unwelcome and unwanted conduct.

__________________________________ Name (optional)	__________________________________ Name of alleged harasser
Phone: ____________ Date: ____________
Female	Female
Male	Male
Undergraduate student	Undergraduate student
Graduate student	Graduate student
Staff	Staff
Faculty	Faculty
Other _________________________	Other ____________________

 

COMPLAINT: (use additional pages if necessary)

 

 

 

 

 

pdf in english                                          pdf in spanish

Amended 2008