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* First Name

* Last Name

* Phone Number

* Email

Street Address

City

State

Zip

* What is your relationship to MSJ?

I am the

I believe I have been, I have witnessed, or I received information that discrimination and or harassment has taken place on the basis of:

For Title IX related incidents. Please check the box that most accurately reflects what you are reporting.

* I believe I have been retaliated against because I opposed that which I believe to be unlawful discrimination in employment or education, filed a complaint, participated in an investigatory process, or reported such behavior required.
Yes No

Involved Parties
Please provide the names and roles of any individuals or organizations involved in the incident, as well as those who may have witnessed it. Please also complete as much of the other requested information as possible.

Click the button labeled Add Party to include more people.

Please add at least one involved party.

Describe in detail each discriminatory and/or harassing behavior that occurred. Please include dates and locations of each action.

Please add at least one incident.

Describe what remedy/desired action you are seeking and why.

If you have any additional documents, emails, or other materials that will assist us in understanding your complaint, please email them to Paige Ellerman, Vice President Compliance, Risk, Legal Affairs/General Counsel/Title IX Coordinator at 513-244-4393, paige.ellerman@msj.edu