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Complaint Form

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Home » About » Campus Offices » Office for Inclusive Excellence » Complaint Form

Campus Offices
- Office for Inclusive Excellence

Complainant Information

You may report anonymously however, please understand this OEI is significantly impaired in the ability to investigate anonymous reports.

Name

Email

Address

Phone

Job Title/Student Status

Select Preferred Communication Method

Phone Email In-Person

Who is your complaint about?

Title/Student Status

Phone

Email

Relationship to you:

Supervisor Subordinate Co-Worker Intimate Partner Acquaintance Other

Please describe what happened and how it is affecting you and your work/life. Additional information (i.e. text messages, images) can be gathered at a later date.

Date(s) incident(s) occurred:

Is it continuing?

Yes No

Please list the name and contact information of any witnesses or individuals who may have information related to your complaint:

(Optional) Have you previously complained or provided information (verbal or written) about related incidents? If yes, when and to whom did you complain or provide information?

By checking this box you understand that, if you have retained legal counsel and would like us to work with them, please provide their contact information.

By checking this box, you affirm that all of the information submitted is true to the best of your ability.

Niagara University, N.Y. 14109
1.800.778.3450
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