UVa-Wise - Compliance Forms

UVa-Wise is committed to maintaining a respectful, professional and nondiscriminatory academic, living and working environment for students, faculty, staff, and visitors.

This includes having an environment free from gender-based and sexual harassment, sexual assault, intimate partner violence, stalking, sexual exploitation, complicity and retaliation (“Prohibited Conduct”). The College will take prompt and equitable action to eliminate Prohibited Conduct, prevent its recurrence, and remedy its effects as described in the Sexual Misconduct and Interpersonal Violence Policy, which may be found at http://www.uvawise.edu/compliance/sexualmisconduct.  

Addtionally, UVa-Wise is dedicated to mutual respect and inclusiveness of its diverse community. Unfortunately, there are times that this respect and civility are breached through acts of bias or disrepect in our community such as slurs based on one's race, gender, national or ethnic origin, or affectational orientation. 

The Be Wise. Report It. Form may be used to alert the College of any instances of Prohibited Conduct or incidents of bias or disrespect in our UVa-Wise community.

REPORTER INFORMATION

As the Reporter, you may submit this form anonymously, by leaving the name and contact information fields blank. If you submit anonymously, however, you should understand that the College's ability to respond to the submitted information will be limited.

In addition, while the College will not attempt to trace anonymous reports to an individual user, various court orders may compel the production of log-in and user data from which certain identifying information later could be obtained.

Name (optional):

Email (optional):

Phone (optional):

INCIDENT INFORMATION

Type of Incident: * - Select -Prohibited ConductBias/Disrespect

Date of Incident:

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Time of Incident:

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am

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Location of Incident:

Description of Incident: *

PROHIBITED CONDUCT -- Please provide as much detail as possible, including the name(s) of the complainant(s) (i.e. "victim"), the name(s) of the respondent (i.e. "perpetrator"), the exact location of the incident (for example, McCraray Hall room #000), the names of any witnesses to the incident, whether the incident involved the use of drugs and/or alcohol, and any other information you may have. Your information will help the College to ensure a safer campus environment and will enable the College to fulfill its obligations, under Title IX, to investigate the incident, remedy its effects, if applicable, and prevent its recurrence.

BIAS -- Please summarize the facts in as much detail as possible. Describe all comments, conduct, gestures, markings, physical injuries, property damage, etc. Identify suspect(s) by name, if known, or by physical appearance (e.g., age, height, weight, race, clothing, distinguising characteristics, etc.), if unknown. List any possible witness(es) by name with contact information, if known.

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