Discrimination, Harassment or Sexual Misconduct Anonymous Complaint Form

Please be advised that anonymous reports will be investigated according to college policy, but our ability to respond may be limited. If you’d like to consider more reporting options, please review the following:

If this is an emergency, please contact Public Safety at 610-921-7670 or dial 9-1-1.

NOTE: Albright College pursues a policy of offering victims of misconduct and witnesses amnesty from minor policy violations related to the incident, such as underage alcohol consumption or drug usage.

This form is designed to provide students, employees, faculty, vendors or contractors, or visitors with an anonymous on-line method for reporting alleged incident(s) of discrimination, harassment or sexual misconduct.

*You are not required to complete the entire form. You have the right to remain totally anonymous when filling out this form. If you are comfortable being contacted, please provide your contact information below.

Name

First

Last

Date of Birth

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Student ID/Employee ID (if applicable)

Harassment, Discrimination and Sexual Misconduct Information:

1. Describe the incident(s) / event(s) including dates, times, locations, and any potential witnesses to the behavior:

2. Please list all witnesses and contact information (if available):

3. Describe the impact that the incident(s) has had on you:

4. Have you taken any action to stop the behavior?

5. Have you reported this incident to anyone else?

6. Have you sought medical treatment? If you wish to seek further medical treatment, a list of on-campus and off-campus providers are listed below.

The Gable Health Center

Tower Health

Penn State Health St. Joseph

7. Resolution – What is the remedy you are seeking?

Report to the local police (Reading PD or Muhlenberg PD)
Report to Public Safety Department
Report to Title IX Office and seek informal resolution
Not sure at this time, but would like to learn about all possible resolutions

Based upon the resolution you have selected above, a member of the appropriate department will reach out for a follow-up meeting.

* By submitting this form, I certify that the information I have provided is true and accurate to the best of my knowledge. This report may be shared with all parties on a need to know basis for investigation. Additional information on college policies can be found in The Compass Student Handbook, the Employee Handbook or Faculty Handbook.

The Compass Student Handbook

Albright College Title IX Notification

Website