This form is designed to provide Adelphi University students, staff, faculty, vendors or visitors with an easy method to report specific information related to an alleged incident(s) of discrimination, harassment (including sexual misconduct), or retaliation.

You are not required to complete the entire form in order for the allegation to be submitted. The University will use the information provided to begin an investigation, which may include contacting the complainant, respondent, and/or any potential witnesses. However, if the report does not contain specific information, the University’s investigation and response may be limited.

  • Reporting Party/Complainant

    If the person completing this form is the alleged victim (hereafter referred to as victim), you may choose to identify yourself or not. If you are a third-party complainant who is not the victim, include the victim’s identifiable information only if the victim wishes.

    Victims completing this form who provide personally identifiable information can expect the University to follow up with an appropriate investigation. For information-only reports, victims should omit all personally identifiable information to ensure confidentiality.

  • If you wish to identify yourself, please provide the information listed below:

  • Type and Basis of Complaint

  • Respondent/Accused Information

    Please identify the person against whom your complaint is made.
  • Complaint

    While providing details is essential to investigate your complaint, please be advised that some or all of the information you provide in this section may be shared with the person(s) you are accusing. You may supplement this description later if you wish to share additional details.
  • Including dates, times, locations, and any potential witnesses to the behavior:
  • Resolution

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