Course Abuse Report Form
Use this form to confidentially report abuse or misconduct related to a course. Please provide as much detail as possible to help us investigate your report.
Your Full Name
*
First Name
Last Name
Your Email Address
*
example@example.com
Your Relationship to the Course
*
Please Select
Student
Instructor
Teaching Assistant
Staff
Other
Course Name or Code
*
Date of Incident
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Type of Abuse or Misconduct
*
Harassment
Discrimination
Bullying
Cheating/Academic Dishonesty
Inappropriate Behavior
Other
Name(s) of Person(s) Involved (if known)
Description of the Incident
*
Were there any witnesses?
*
Yes
No
If yes, please provide the names and contact information of witnesses
Upload any supporting documents or evidence (optional)
Upload a File
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Choose a file
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What action would you like to see taken?
Submit Report
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