EmailMe Form - Harassment/Discrimination, Title IX, & Retaliation

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

NOTE 1: You are not required to complete this form to file a complaint or concern. You may choose to speak directly with someone. For additional assistance, visit: www.abac.edu/titleix/

NOTE 2: If you choose to complete this form, the College will use the information provided to begin the complaint intake process, which may result in a formal investigation that would include contacting the victim, the alleged, and any potential witnesses. If the report does not contain specific contact information, the College's response may be limited.

Additional information on the University System of Georgia's Sexual Misconduct Policy and Title IX reporting structure can be found at www.usg.edu/policymanual/section6/C2655.

BACKGROUND INFORMATION

Please fill in the information listed below if you wish to identify yourself.

If the person completing this form is the victim, you may choose to identify yourself or not. If you are a third-party complainant who is not the victim, please include the victim's name. If you do not know the SID (Student Identification number), leave it blank and that information can be found later by a College Official.

Your full name:

First Last

Your position/title:

Your phone number:

### - ### - ####

Your email address:

Type of Complaint *

Date of incident: *

MM / DD / YYYY

Time of incident:

HH : MM AM/PM

Location of incident: *

Specific location:

INVOLVED PARTIES

Please identify the person(s) whom the complaint is made.

Name or Organization

Select Gender

Select Role

Student ID Number

(if known)

Phone number

### - ### - ####

Email Address

Residence Hall or Address

Add another party

Name or Organization

Select Gender

Select Role

Student ID Number

(if known)

Phone number

### - ### - ####

Email Address

Residence Hall or Address

Add another party (2)

Name or Organization

Select Gender

Select Role

Student ID Number

(if known)

Phone number

### - ### - ####

Email Address

Residence Hall or Address

Add another party (3)

Name or Organization

Select Gender

Select Role

Student ID Number

(if known)

Phone number

### - ### - ####

Email Address

Residence Hall or Address

Add another party (4)

Name or Organization

Select Gender

Select Role

Student ID Number

(if known)

Phone number

### - ### - ####

Email Address

Residence Hall or Address

QUESTIONS

While providing details is essential to start the complaint process, 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.

If this is a discrimination or harassment complaint, please indicate the protected status(es) that is/are the basis of the alleged behavior.

Describe the incident(s)/event(s), including date, times, locations, and any potential witnesses to the behavior. *

Describe the impact the behavior has had on you.

Have you taken any action to stop the behavior?

If you have taken action to stop the behavior, what actions have you taken, and what was the outcome?

Please add any additional information that supports your complaint.

What remedy are you seeking?

SUPPORTING DOCUMENTATION

Please add additional documents supporting your complaint—5 GB maximum total size. Attachments require time to upload, so please be patient after submitting this form.

Choose file(s) to upload