Discrimination or Harassment Report

Prior to submission of this form, if you have questions regarding the college's response to allegations of discrimination or harassment, or to discuss options available to you, please contact the Director of Equal Opportunity at 407-582-8125 or via email: equalopportunity@valenciacollege.edu.

Fields marked with a must be filled out to submit the form.

Contact Information
Your Relationship to Valencia College

Involved Parties

Please write down the names of the parties involved. Please include all the information you have such as name, phone, email and relationship.


Incident Information
Alleged Behavior

(select all that may apply)

Definitions

Alleged Protected Status

(select all that may apply)

Detailed description of alleged misconduct.


Agreement

By checking this box, I am requesting that Valencia College take appropriate action to respond to this allegation. I acknowledge that I and/or the Complainant will be contacted by a representative of the College who will provide the Complainant with additional detail regarding supportive measures available as well as detail regarding the College’s process as outlined in 6Hx28:2-01-Discrimination, Harassment and Related Misconduct . I also acknowledge that the College’s ability to effectively respond to the allegations may be impacted by the Complainant’s willingness or ability to provide information and to participate in any process as defined in College Policy 6Hx28:2-01.