The City University of New York
Sexual Misconduct Allegation Form
This form may be used by reporting individuals or complainants, including employees, students and
visitors, who wish to file a complaint of sexual harassment, gender-based harassment and/or sexual
violence pursuant to CUNY’s Policy on Sexual Misconduct. CUNY’s policy prohibits retaliation
against any person who reports sexual misconduct, assists someone making such a report, participates in
any manner in an investigation or resolution of a sexual misconduct complaint, seeks interim or supportive
measures or accommodations pursuant to CUNY’s Policy on Sexual Misconduct, or opposes in a
reasonable manner an act or policy believed to constitute sexual misconduct.
EMPL ID Number
Status (e.g. Student, Alumnus,Faculty, Staff, Visitor):
1. Have you previously filed a complaint?
If so, when and to whom did you file it?
2. Have you filed this allegation with a federal, state or local law enforcement/agency?
If yes, with which agency?
If no, why?
Do not want to report Need assistance in reporting Other
If you chose other, please state the reason:
3. Do you have an order of protection (OOP) in this matter?
If yes, is this order permanent or temporary?
Temporary Next Court Date