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Title VI and VII Complaint / Report Form For Allegations or Discrimination

Submission will be made to Office of Institutional Diversity and Equity (OIDE). You can submit this form at the bottom of the webpage. 


Your Information

Please complete the following:











 




If you are an employee, please complete the following:



OPTIONAL - Complete any categories below that may be relevant this complaint

Complaint Information

Please be as complete and specific as possible.


 



 





 







Please answer the following questions as thoroughly and completely as possible.




Certification

I swear or affirm that I have read the above allegation and that it is true to the best of my knowledge, information or belief.

I understand that I should keep all information learned during the complaint investigation process should be kept confidential by Complainants and Reporting Individual's and that the Office of Institutional Diversity and Equity (OIDE) keeps all information gathered relative to allegations of discrimination in confidence to the extent practicable or allowable by law. However, OIDE may provide relevant information to the appropriate University staff as necessary.

I understand that it is a violation of State and Federal law and Stony Brook University policy for anyone to retaliate against any individual involved in an investigation of discrimination. I understand that if I am subjected to any adverse action that I feel may be retaliatory it should be reported immediately to OIDE.

I understand that the filing of an internal complaint with Stony Brook University is not a waiver of my right to file a formal complaint of unlawful discrimination with the New York State Division of Human Rights, the Equal Employment Opportunity Commission (EEOC), the Federal courts, or the State courts.

I understand that the filing of an internal complaint does not stop the statute of limitations for filing external complaints with EEOC, the NYS Division of Human Rights, litigation, or any other agency hearing such complaints. I am aware that should I choose to file a verified complaint with an outside agency, such a complaint must be filed with EEOC within 180 days of the alleged incident, and with the State Division of Human Rights within 365 days of the alleged incident.

I understand policy and the information contained in it does not constitute legal advice. If you require legal advice, consult an attorney. By submitting this form, I am certifying the above statements to be true and factual to the best of my knowledge.





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