Roosevelt University in Chicago, Schaumburg and Online - Logo

Submit a Complaint

This form is to be used to report complaints and/or issues of any level of importance, including sexual harassment, attempted or completed sexual violence, stalking, intimate partner or dating violence, or discrimination based on sex in a university program or activity. 

Resources

You do not have to use this form to make a complaint, report wrongdoing or receive assistance. The following resources are available to you:

Complaint Form

Please fill out as much information as possible based on your knowledge of the situation. You may submit an anonymous report; however, without the contact information of the complainant and the ability to investigate further, the university may be limited in how it can respond.

Complainant Information

The "complainant" is the individual who submits the report and has been directly affected by the issue. The complainant may be the victim, a witness or another person who knows about an incident or situation.

required for Faculty/Staff only
Victim Information

Only provide this information if it is different from above. The "victim" is the individual who experienced the violation or harm.

required for Faculty/Staff only
Respondent #1 Information

If known, please provide information below. The "respondent" is the individual accused of perpetrating the violation or harm. If there are more than 2 respondents that need to be listed, please note that in the description of events.

required if respondent is a member of the Roosevelt Faculty/Staff
Relationship to Victim





Choose all that apply.
Respondent #2 Information

If known, please provide information below. The "respondent" is the individual accused of perpetrating the violation or harm. If there are more than 2 respondents that need to be listed, please note that in the description of events.

required if respondent is a member of the Roosevelt Faculty/Staff
Relationship to Victim





Choose all that apply.
Incident Information

Describe the incident as clearly as possible. Include a full description of the events, verbal statements made, the location, and what, if any, physical contact was involved. If there has been a pattern of behavior or multiple incidents, please note that in this section.

List any witnesses who were present or may be able to provide relevant information.
I have also reported this to:









Certification

By checking the box below and submitting your digital signature, you are acknowledging the statements in this report are factual to the best of your knowledge.