Sexual Misconduct Allegation Form

Diversity & ComplianceSexual Misconduct Allegation Form

This form is to be used to file a complaint of sexual misconduct. You may use this form to report any incidents of sexual misconduct including Dating Violence, Domestic Violence, Sexual Assault, Sexual Harassment, Stalking, Voyuerim, Harassment based on sexual orientation, gender, gender expression and gender identity. If you have additional complaints you may indicate that in the "Questions and Additional Concerns'" section at the end of this form.

All forms are submitted to the Title IX Team and reviewed by team members, including the Title IX Coordinator and Title IX Deputy Coordinators. Information in this form will remain private and only shared on a strict need to know basis for purposes of supportive measures and/or investigations.

*Information provided in this form is not confidential. If you would like to speak to a confidential resource you can go to Counseling and Wellness or Pastoral Counselors on campus, if you are an employee you may use the CUNY Work/Life Assistance Program.

Today's Date Today's Date * / MM / DD YYYY
Your Name Your Name First Last
What is your role *

What is your role Hunter Student Hunter Faculty Hunter Staff (non-faculty) Parent of Hunter Student CUNY Student (non-Hunter) CUNY Employee (non-Hunter) No CUNY or Hunter Affiliation - Visitor Other Other
If you are a CUNY member but not affiliated with Hunter College, please list your CUNY school
Date of Incident Date of Incident * / MM / DD YYYY
If misconduct occurred on multiple dates please list them here:
Location of Incident *

You may write a general answer such as off campus or on campus, or specify the exact location.
How were you affected? *

How were you affected? Directly Witness Third Party Non-Witness Other Other
Would you like to remain anonymous

Would you like to remain anonymous Yes No

Please note, for a formal Title IX complaint you may not remain anonymous. However, if the allegations are investigated under Non-Title IX Sexual Misconduct you may remain anonymous to the best of our abilities. The choice to remain anonymous may also impact the supportive measures we can coordinate.
Alleged Accused/Respondent's Name Alleged Accused/Respondent's Name * First Last
You may write "Unknown" or "Withheld." Please know, we may not be able to investigate allegations where the Accused is not named or unknown.
What is the role of the Accused? *

What is the role of the Accused? Hunter College student Hunter College Staff/Faculty CUNY student (Non-Hunter) CUNY Faculty or Staff (Non-Hunter) Field Placement Outside of CUNY, unafilliated - Visitor Other Other
If the Accused is not affiliated with Hunter but is a member of another CUNY school, which campus?
Alleged Sexual Misconduct (check all that apply) *

Alleged Sexual Misconduct (check all that apply) Sexual Harassment Harassment based on Gender, Gender Identity, Gender Expression, Sexual Orientation Stalking Sexual Assault: Touching Sexual Assault: Penetration/Rape Domestic Violence Dating/Intimate Partner Violence Voyuerism Retaliation Other Other

For information as to these definitions please see the CUNY Policy on Sexual Misconduct 2020 on the Title IX website: http://www.hunter.cuny.edu/diversityandcompliance/title-ix

Retaliation = this refers to retaliation for participating in an investigation, reporting an incident of sexual misconduct or being accused of sexual misconduct
Please share, what you are able to, about the events or facts surrounding these allegations: *
Do you want to file a formal complaint and have these allegations invested by the Title IX Team?

Do you want to file a formal complaint and have these allegations invested by the Title IX Team? Yes No Unsure
Please list any witnesses or individuals with information regarding the allegations (provide names and contact information)
Have you reported this incident to anyone else on campus? If so, who?
Have you reported this incident(s) to outside law enforcement?

Have you reported this incident(s) to outside law enforcement? No Yes
Are you familiar with the support services on Campus?

Are you familiar with the support services on Campus? Yes No

In addition to on campus resources we also have external resources that can be found on our website http://www.hunter.cuny.edu/diversityandcompliance/title-ix
Which of these Support Services do you need:

Which of these Support Services do you need: Academic acomodations Enforcement of Court Ordered Restraining Order or Order of Protection Class Schedule Work Schdeule/Assignment No Contact Order/Directive Reasonable Accomodations Counseling Escort by a Public Safety Officer Student Housing Rearrangements Assistance Reporting to Outside Law Enforcement

Supportive measures and accommodations are available to complainants, respondents and other affected parties, regardless if there is a formal complaint and/or investigation.
Which of these support services do you need: *
Are there any services/resources that you are interested in knowing more about:
Please upload any supporting documents

Maximum file size: 3MB.

Attach Files

If there is a formal complaint and investigation, you may submit more evidence at a later time. Please note that if you choose to go that route, you may want to preserve evidence such as documents, pictures, text messages, social media, etc.
Additional Comments/Notes/Impact Statement
If you chose to not remain anonymous please give your contact information below

You may chose to disclose your personal information to the Title IX Team, while also choosing to remain anonymous to the Accused/Respondent. Please indicate below in "Additional Comments/Notes" if you do not want your information shared with the Accused/Respondent.
Phone Phone - ### - ### ####
EMPL ID
Email
Questions or Additional Concerns
Title IX Coordinator at Hunter College

John T. Rose
John.rose@hunter.cuny.edu
(212) 772-4242
East Building 17th Floor
http://www.hunter.cuny.edu/diversityandcompliance/title-ix

Title IX Team email: TitleIX@hunter.cuny.edu