Diversity & Inclusion : Report Incidents Anonymously

If you have an emergency, please call 911.

The UGA College of Veterinary Medicine is a community where diversity and inclusion are valued. If you've experienced or witnessed an event at the college that you feel violates our stand on diversity and inclusion, you are encouraged to report it below.

Reporting Party

Reporting Party:

First Last

Reporting Party Title:

Reporting Party is the alleged victim:*

Yes

Department:

Contact Phone Number:

UGA Email Address:

Status:

Student

Faculty

Staff

Other

Request Confidentiality:*

Yes

Basis of Complaint

Basis of Complaint (Check all that apply.)

If Other - Please List:

Respondent (person alleged to have violated the CVM's policy)

Respondent Name:*

First Last

Respondent Title (if applicable):

Department:

Contact Phone Number:

UGA Email Address:

Status:

Student

Faculty

Staff

Other

Details of Complaint

Date of Incident

Choose a date.

Time of Incident

Hour

Minutes

Location of Incident

Clarifying Location Information if Needed

A) Describe incident of discrimination or retaliation.*

Describe incident of discrimination or retaliation. Please be as detailed as possible, giving names, date, and place of incident.

B) Witnesses*

List those witnesses you believe have information about your complaint. Include complete information for each witness listed. If the Reporting Party is not the alleged victim, please identify the alleged victim as a witness. If no witnesses, enter N/A.

Additional Information

Previous Report?*

A) Have you previously reported or otherwise complained about this or related acts of harassment, discrimination or retaliation to a CVM supervisor or official? If so, please identify the individual to whom you made the report, the date you made the report, and the resolution. If not, enter N/A.

Resolution:

What would resolve this complaint?

CAPTCHA

Diversity Anonymous Complaint