EthicsPoint

ETHICSPOINT IS NOT A 911 OR EMERGENCY SERVICE.
Do not use this site to report events presenting an immediate threat to life or property. Reports submitted through this service may not receive an immediate response. If you require emergency assistance, please contact your local authorities.

* Yes - I agree to the Terms and Conditions of making this report.

Please provide information as follows:
( * Required fields )

Organization/Tier:	Texas Tech University Health Sciences Center El Paso
Location where incident occurred:	Physical address, branch and/or store number
City:	State/Province:
Zip/Postal Code:
Country:

* Do you wish to remain ANONYMOUS for this report?

Yes No

If you want Texas Tech University Health Sciences Center El Paso to know your identity, please complete the following:

Your Name:


First Name	Last Name

Your Phone Number:

Your Email Address:

Best time for communication with you:

* Relationship to Institution

Report - Title IX/Sexual Misconduct

What is the general nature of this matter?

	This should be a general description only, you will be asked for specifics later.

* How did you become aware of this possible violation?

If other, how?

Where did this incident or possible violation occur?

	We recognize that this incident may not have occurred in a particular location. However, if this incident was observed in some documentation or business transactions, please indicate this accordingly.

Please provide the specific or approximate time this incident occurred.

<font color="#000000">Examples:<br><br>Tuesday, May 3, 2002<br>Two weeks ago<br>Approximately a month ago</font>

What policy or procedure do you think was violated and how?

* What specific resolution do you seek?

* Do you have any immediate concerns of health or safety?

Yes
No

If yes, please explain.

* Did you seek medical attention for this incident?

Yes
No

If yes, please explain.

If you are completing this form for someone else, please include their name and contact information.

	First Name	Last Name		Title
#1			-
#2			-
#3			-

* Please identify the person(s) you feel are engaged in this behavior.

	First Name	Last Name		Title
#1			-
#2			-
#3			-

<font color="#000000">Any persons mentioned here will be restricted by EthicsPoint to access to this reported information.</font>

Have you or someone else previously reported this problem to your supervisor or management? If so, by whom, to whom, when, and how?

If you have documentation that support(s) your report, most common files types can be uploaded:

* Please provide all details regarding the alleged violation, including the locations of witnesses and any other information that could be valuable in the evaluation and ultimate resolution of this situation.

Please take your time and provide as much detail as possible, but exercise care to not provide details that may reveal your identity unless you wish to do so. It may be important to know if you are the only person aware of this situation.

When you submit the report, you will be issued a Report Key. Please write it down and keep it in a safe place. We ask you to use this Report Key along with the password of your choosing to return to EthicsPoint through the website or telephone hotline in 10 business days. By returning in 10 business days, you will have the opportunity to review any Follow-up Questions or submit more information about this incident.

Please choose a password for this report:
* Password:
* Re-enter Password:
Your passwords must match and be at least four characters long.