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Unlawful Discrimination Complaint Form


Do not use this form to report events presenting an immediate threat to health or safety. If you require emergency assistance, please dial 911.

Students or Employees may use this form to report an incident involving an allegation of unlawful discrimination, harassment, retaliation, sexual misconduct, dating violence, domestic violence, and/or stalking. Board Policies and Administrative Procedures are available online for more information.

Complainant / Reporting Party Options
Complainants may request informal resolution or formal investigation of their complaint. This form is not an anonymous reporting option.

Students and adjunct faculty seeking non-reporting, confidential resources may speak to a Licensed Mental Health Counselor at the Student Health Center. Full-time Faculty seeking non-reporting, confidential resources may contact the Employee Assistance Service for Education (EASE) Program. Classified, management, confidential, and auxiliary employees seeking non-reporting, confidential resources may contact the Employee Assistance Program (EAP).

Informal Resolution may include: efforts to uniformly resolve the charges, including but not limited to mediation, no contact orders, rearrangement of work/academic schedules, obtaining apologies, providing informal counseling and/or training, etc. When complainants opt for informal resolution, the Title IX Coordinator, or designee, will determine whether further investigation is necessary to ensure resolution of the matter. Under Title IX, the informal resolution process is not available for complaints by a student against an employee of sexual harassment, including: sexual assault, dating violence, domestic violence, or stalking.

Formal Investigation is required when the nature of the alleged conduct is severe and/or the complainant seeks disciplinary action for a student or employee. Formal resolution includes an investigation and administrative determination within approximately 90-days of lodging complaint with the Title IX Coordinator or designee. The Title IX Coordinator or designee may proceed with a formal investigation after assessing the complainant's request for informal resolution.

If you are unsure or would like to speak to someone about completing this report form, please call or email the Office of Title IX & EEO Programs at 909-274-5249 or eeo.titleix@mtsac.edu. Normal business hours are Monday - Thursday 8 AM - 5 PM, and Friday 8 AM - 4:30 PM.

Background Information

 
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For employees, list your job title. If you are a student, write
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i.e. Building #; Room #; Parking Lot #; address; Other detailed information

Involved Parties

To the best of your knowledge, please provide the names and indicated information of the complainant, respondent and witnesses (including yourself).
Reporting Party / Complainant is the person who experienced the misconduct or victim.
Accused / Respondent is the person who the complaint is against or perpetrator.
Witnesses are individuals who can provide relevant information about the incident(s).

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Questions

Please answer the follow questions to the best of your knowledge.

Please indicate the type(s) of complaint being filed: (check all that apply)
You must make at least one selection.
If Discrimination, Harassment, or Retaliation were selected, please indicate the protected category that was the basis of the Discrimination, Harassment, or Retaliation. (check all that apply)
You must make at least one selection.
If you were subjected to and selected sexual harassment, sexual assault, dating violence, domestic violence or stalking, please indicate whether you are requesting the College investigate.
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Checking the box below, "I agree", represents my digital signature and I certify the information I provided is correct to the best of my knowledge.(Required)
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Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission