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HR Form

If you feel that you or someone at the College has been a victim or discrimination, harassment or sexual misconduct, please complete the form below. You can find information on Hood College’s Policy by clicking on Prevention and Resolution of Discrimination, Harassment and Sexual Misconduct (Policy 55) and you may click on information regarding the College’s Nondiscrimination Policy

Please be advised that you may submit an anonymous report. The College will respond to situation based on the information provided.

Required fields are marked with an asterisk (*)

Complainant Information

  1. Please specify the relationship the individual has with the College.
                                                  

Type of Complaint

  1. : “A form of harassment that is a reckless or intentional attempt by a single group, to demean, intimidate, or abuse another individual, or to create a hostile or offensive environment.”
  2. “Treating one individual differently from another individual with respect to the terms and conditions of her/his employment or student status based on a currently protected status (see list below) under federal, state, or local anti-discrimination statutes.”
  3. : “Any action or attempt by an individual or group which has the intention and/or effect of preventing another individual or group from filing, pursuing, or exploring a report, grievance, and/or remedy as provided for in Policy 55.”
  4. : “Harassment is an attempt to demean, intimidate, or abuse another individual, or to create a hostile or offensive environment on the basis of another’s currently protected statutes (see list below) under federal, state, or local anti-discrimination statues/”
  5. : “is a broad term that encompasses sexual violence, nonconsensual sexual contact, sexual harassment, sexual assault, sexual exploitation, sexual intimidation, and relationship violence.”
  6. : “Engaging in a course of conduct directed at a specific person that would cause a reasonable person to fear for her/his safety or the safety of others and or suffer substantial emotional distress.”
                                                

If complaint discrimination is chosen:

                              

If complaint harassment is chosen:

                             

Relationship to the incident: check all that apply

                                              

Details regarding the incident:

  • Date:
  • Time:
  • Location:
  • Number of people involved in this incident:
  • Name of targeted individual or group:
  • Names of people involved if known:
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Detailed description of each alleged perpetrator(s):

    Perpetrator 1

  • Alleged perpetrator number one name:
  • Height:
  • Weight:
  • Gender Identification:
  • Race/Ethnicity:
  • Age:
  • Status
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Perpetrator 2

  • Alleged perpetrator number two name:
  • Height:
  • Weight:
  • Gender Identification:
  • Race/Ethnicity:
  • Age:
  • Status
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Perpetrator 3

  • Alleged perpetrator number two name:
  • Height:
  • Weight:
  • Gender Identification:
  • Race/Ethnicity:
  • Age:
  • Status
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  • Please describe the incident in detail and how it is an alleged violation of Policy 55.
     
  • Is this a one-time occurrence or has there been a similar incident previous to this one? If Yes, please describe the previous incident including all relevant information.
     
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Witnesses

Witness one

  • Name:
  • Relationship:
  • Telephone:
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Witness two

  • Name:
  • Relationship:
  • Telephone:
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Witness three

  • Name:
  • Relationship:
  • Telephone:
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  • Is there other information that the College should know in regards to this incident?
     
  • Have you used College resources to help you with this incident:
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If you have used College resources, please indicate all of the ones that you used to help you after the incident(s)

  1. Please specify the relationship the individual has with the College.
                                                  
  • How helpful was/were the resources?
  • Do you feel that you are safe on campus after this incident?
  • If no, please specify what you need to improve your level of safety:
     
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If you chose not to use appropriate College Resources, please indicate why:

                                                  

Please indicate what additional support you may need at this time:

                                                  
  • By submitting this report, I understand that the College will act on this notification by beginning a prompt and impartial investigation relying on this information. I further acknowledge that the College may need to provide information contained in this complaint to the respondent as part of a fair and impartial investigation and/or grievance process and in order to take appropriate steps to prevent recurrence of the discrimination, harassment or sexual misconduct in this complaint. I acknowledge that Hood College will take steps to prevent retaliation as a result of this complaint being received and processed. In the event that I determine that retaliatory behavior is being exhibited toward me, I understand the need to inform appropriate College officials to address this behavior. By submitting this online complaint form, I certify that the aforementioned information provided is true and correct. False reports will be processed in accordance with the appropriate Hood College process and may involve subsequent legal action for the false report. At this time, I would like this to be considered: Choose one option below.

    Informal process: The complainant in consultation with the Ombudsperson will determine an appropriate approach to resolving the complaint. It may include direct communication between the complainant and the respondent or mediation individually or jointly as provided under the grievance process. Please note that sexual misconduct complaints are not subject to mediation under the Campus Save Act.

    Formal process: The College will work to insure an adequate, reliable, and impartial investigation and resolution of complaints through the use of appropariate training for responsible College officials and grievance board members, the multi-level review structure, the pre-appointment of grievance boards, and, as appropriate the appeal process.

Reporter information

  • Please indicate your association with Hood College:

  • If you are a student, faculty or a staff member, please indicate your status below:

  • Student
  • Faculty
  • Staff
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Contact information

    Thank you for being willing to report this information. Please provide as much information as you can to assist us in our investigation of the matter.  You can request a private, confidential meeting with the ombudsperson for additional assistance.  You may reach the ombudsperson through a confidential email ombus@hood.edu or via a confidential telephone line at 301-696-3592.

  • First name:
  • Last name:
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  • Email:
  • Phone:
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  • Address 1:
  • Address 2:
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  • City:
  • State:
  • Zip:
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