EthicsPoint

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ETHICSPOINT IS NOT A 911 OR EMERGENCY SERVICE. Do not use this form to report immediate threats to life or property. If you require emergency assistance, please contact the Harvard University Police Department at (617) 495-1212 or contact your local authorities. Disclosures of sexual harassment and/or other sexual misconduct submitted through this service may not receive an immediate response.

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

Please provide information as follows:
( * Required fields )

Organization/Tier:	Harvard University Title IX Office

<div id="anonymity-preference">Your Anonymity Preferences</div>

* Do you wish to remain ANONYMOUS for this report?

Yes No

If you want Harvard University Title IX Office 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:

Report - Sexual and/or Gender-Based Harassment

* What is your affiliation with Harvard University?

* How did you become aware of the incident(s) or conduct?

If other, please explain.

* Please describe the incident(s) or conduct. <span style="font-weight:400;">You may share as much or as little as you feel comfortable.</span>

* Enter the name and title, if known, of the person(s) engaged in the incident(s) or conduct. <span style="font-weight:400">If you do not know the name of the person(s) engaged in the incident(s) or conduct or their title, enter “Unknown.”</span>

<br><br><div class="tip-cols"<br><div class="tip-col">Examples:</div><br><div class="tip-col">J. Doe, Manager<br>Alex Doe, Teaching Fellow<br>Lee Unknown, Student</div><br></div

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

Please also provide the affiliations, if known, of the person(s) engaged in the incident(s) or conduct.

Person 1.

Person 2.

Person 3.

<span id="radio-bts">Have you accessed Harvard resources regarding the incident(s) or conduct?</span>

Yes
No
Do Not Wish To Disclose

<div class="unindent">If yes, then which resources? Examples: Harvard Title IX Resource Coordinator, Sexual Harassment/Assault Resources & Education (SHARE) Counselor, Harvard University Police Department (HUPD), etc.</div>

* <span id="radio-bts2">Did the incident(s) or conduct occur on Harvard property or during a Harvard program or activity?</div>

Yes
No

* Please provide additional detail about where the incident(s) or conduct occurred.<span style="font-weight:400;font-size:16px"> We recognize that the incident(s) or conduct may not have occurred in a particular or single location. You may also indicate if the incident(s) or conduct occurred online (e.g., email, social media).</span>

	<br><br><div class="tip-cols"<br><div class="tip-col">Examples:</div><br><div class="tip-col">Dorm room in XYZ House<br>XYZ Lab<br>XYZ Study Abroad Program<br></div><br></div

Please provide the date(s) and/or time(s) when the incident(s) or conduct occurred.

	<br><br><div class="tip-cols"<br><div class="tip-col">Examples:</div><br><div class="tip-col">Tuesday, May 3, 2002<br>Two weeks ago<br>Approximately a month ago<br></div><br></div

You may also upload documents, images, or other files related to your disclosure (most common file types are supported).

* Please provide any additional information you would like to share about the incident(s) or conduct or any questions you may have for the Harvard Office for Gender Equity.

When you submit this disclosure form, 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 in 2 business days. By returning in 2 business days, you will have the opportunity to review any resources and follow-up questions sent by the Harvard Office for Gender Equity or submit more information about this conduct.

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