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Discrimination and Harassment Reporting Form


Forms are typically reviewed within 1 business day. If this is an EMERGENCY situation, CALL 911 or contact the Department of Public Safety at 609-896-7777. Do not use this form to report events that present an immediate threat to health or safety.

Please only use this form to report incidents of discrimination, bias, or discriminatory harassment.

To report incidents of Sexual Violence, including sexual assault, dating violence, domestic violence, and stalking, please fill out this form.

Anonymous reports or reports without complete information may limit the University's ability to respond.

Questions you may have:

Q: When should I fill out this form?

A: When you wish to report an incident of discrimination, bias, or discriminatory harassment.

Q: There are multiple forms listed above, what if I fill out the wrong one?

A: Do not be concerned if you fill out the wrong form. Administrators on campus work collaboratively and if a report is better addressed by another office, the information will be shared as needed.

Q: Can I fill out the form anonymously?

A: You can fill out the form anonymously. Depending on the information shared, the University may be limited in the response and follow up it can do.

Q: Who is going to see the information I fill out?

A: The information provided in these forms is typically shared with the Title IX Coordinator, the Title IX Compliance Officer, and members of the Department of Public Safety. It may be shared with additional administrators as needed, while taking into consideration the privacy rights of all individuals involved, to appropriately address the situation.

Q: Will I hear back from someone?

A: You may be contacted about the information you have entered into the form as long as you provide contact information. The individual who has been identified as being targeted by the alleged behavior, when identified, will also be contacted in most instances.

Q: Do I get a copy of my report?

A: You will automatically be sent a copy of your report as long as you enter a valid email address and do not select out of receiving a report at the bottom of this page. If you do not list an email address, a report cannot be shared with you. Besides a copy of the report, you will also receive information regarding resources, policies, and administrators you may wish to contact.

If you have additional questions or wish to contact someone directly, please email Tom Johnson at tjohnson@rider.edu.

Background Information

Anonymous reporting may limit the university's ability to follow up on a report. If you wish to receive a copy of the report you must supply a valid email address.

 
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If you wish to receive a copy of the report you must supply a valid email address.
This field is required.
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Please select who engaged in the alleged discrimination or harassment behavior.
This field is required.
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Enter today's date if incident date not know.
This field is required.

Involved Parties

Please include the information you wish to share. If you do not know the name of the Respondent, please type, Unknown Respondent in the name field.




Definition of Roles:

  • Complainant: The individual who experienced the alleged behavior. When a complainant (a person targeted by the alleged conduct) is identified in a report and a member of the university community, the Title IX Coordinator (or designee) will contact that individual to schedule a meeting to discuss resources available to that individual and the university's grievance process.
  • Respondent: The individual who engaged in the alleged behavior.
  • Witness: An individual who has a first-hand account of the alleged behavior.
  • Bystander: An individual who has a first-hand account of the alleged behavior and who tried to intervene to stop the alleged behavior.
Involved party 1

Questions

Type of Incident(Required)
You must make at least one selection.
This field is required.
Type of Bias (or Protected Class)(Required)
You must make at least one selection.
This field is required.
How would like to be contacted about this report (please ensure you provide your contact information above if you would like to be contacted)(Required)
This field is required.
Have you reported this incident to the Department of Public Safety?(Required)
This field is required.
Has this incident impacted your education or employment at the university?(Required)
This field is required.

Supporting Documentation

Please upload any supporting documentation, such as screenshots.
5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission