* Indicates a required field

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 and/or gender-based harassment submitted through this service may not receive an immediate response.

   *

Please provide information as follows:
( * Required fields )

Organization/Tier: Harvard University Title IX Office

Your Anonymity Preferences
        
         * Do you wish to remain ANONYMOUS for this report?
                      
         
If you want Harvard University Title IX Office to know your identity, please complete the following:
Your Name:
 
          
                

Report - Sexual and/or Gender-Based Harassment
*
        
*
        
          
                
*
        
*Enter the name and title, if known, of the person(s) engaged in the incident(s) or conduct. If you do not know the name of the person(s) engaged in the incident(s) or conduct or their title, enter “Unknown.”
        

Examples:

J. Doe, Manager
Alex Doe, Teaching Fellow
Lee Unknown, Student

        
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.
                
          
                
          
                
          
                
Have you accessed Harvard resources regarding the incident(s) or conduct?
        


          
                
*Did the incident(s) or conduct occur on Harvard property or during a Harvard program or activity?
        

*
        

Examples:

Dorm room in XYZ House
XYZ Lab
XYZ Study Abroad Program

        
        

Examples:

Tuesday, May 3, 2002
Two weeks ago
Approximately a month ago

        
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 Title IX Office.

  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 Title IX Office or submit more information about this conduct.
Please choose a password for this report:
*
*
Your passwords must match and be at least four characters long.