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Discrimination, Harassment, Sexual Misconduct, and Retaliation (Title IX and Equity) Report Form


If you need to report an emergency, do not use this form. Instead, call Campus Security at 203-576-4911 or dial 911

Submission Instruction: This form can be used by any member of the University of Bridgeport community wishing to file a report of Sex-Based Misconduct (sexual harassment, sexual assault, dating/domestic violence (Intimate Partner violence), and stalking, or any form of discrimination or harassment based on a protected status such as but not limited to; Age, Sex, Gender identity, Sexual orientation, National origin, Race, Religion, Marital status, Phsycial disability, and Mental disability. The Office of Civil Rights will review the information provided and take appropriate action, including offering support services and discussing your resolution options and rights.

Providing contact information is optional However, if you submit this form anonymously, it will impede the University of Bridgeport’s ability to investigate and to address the incident.

By submitting this report, you are stating that all information contained in the report is correct to the best of your knowledge.

Student records at the University of Bridgeport are subject to the Family Educational Rights and Privacy Act (FERPA), which protects the privacy of educational records and allows students to inspect and review their records.

If you include contact information, the Office of Civil Rights Compliance will attempt to contact you (or the victim/complainant of the reported assault/incident) within one business day to discuss the matter.

Background Information

Should you not include your contact information this form will be considered an Anonymous Report. Based on the information contained in this report, university administration may investigate and take action as warranted.

 
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Choices are: Faculty, Staff, Student, Other
Email address must be of a valid format.
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Involved Parties

Please list all individuals involved including any witnesses and excluding yourself. Provide information on as many of the fields below as possible.

Involved party 1

Questions

Please provide as much information as possible.

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Was medical treatment sought relating to this incident?(Required)
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Was Law Enforcement/Security involved in this incident?(Required)
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Is the Reporting Party, or Victim/Complainant requesting information from the Office of Civil Rights Compliance such as:
You must make at least one selection.

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