Harassment and Discrimination Incident Report Form
Sexual MisconductStudent Health & Wellness

Harassment and Discrimination Incident Report Form

Please use this form if you feel you have experienced, heard or witnessed an incident of discrimination-related harassment. You can use this form to make an anonymous report or you may attach your name, either as the person who experienced the incident or a third party. Gonzaga University will not tolerate harassment and discrimination based on race, gender, sex, religion, national origin, ethnicity, age sexual orientation, disability or any other characteristic or trait protected by law. The University’s harassment and discrimination policies and procedures are designed to stop discriminatory harassment, prevent its recurrence, and address its effects.

A University official may contact you for additional information about the incident, to discuss options, and address immediate needs you have for assistance.
Do Not Edit:
Do Not Edit:
Do Not Edit:
Don't Edit This Field:
* = Required Fields
Incident Information
Witness to harassment Target of harassment
Male Female
If you are not the person who experienced the incident, but a third party, please provide the following information for that person:
Male Female
Gender Disability Race Ethnicity Sexual Orientation National Origin
Age Religion Veteran/Military Status Other
Male Female Student GU Employee/Staff GU Faculty Non-student Unknown
* Was the incident reported to any other department on campus or to a university official? Yes No
* Was the incident reported to any police agency? Yes No
Thank you for taking the time to report this incident and help us combat harassment and discrimination at Gonzaga University.