The City University of New York/College of Staten Island

Sexual Misconduct Complaint Form

This form may be used by reporting individuals or complainants, including employees, students and visitors, who wish to file a complaint of sexual harassment, gender-based harassment and/or sexual violence pursuant to CUNY’s Policy on Sexual Misconduct. CUNY’s policy prohibits retaliation against any person who reports sexual misconduct, assists someone making such a report, participates in any manner in an investigation or resolution of a sexual misconduct complaint, seeks interim or supportive measures or accommodations pursuant to CUNY’s Policy on Sexual Misconduct, or opposes in a reasonable manner an act or policy believed to constitute sexual misconduct.

PART A (PLEASE PRINT OR TYPE)
Contact/Cell Number Format (###)###-####
PART B

Summary of Sexual Misconduct Complaint