Intake Form

This form will provide the Office for Diversity, Equity, and Inclusion (DEI) with basic information regarding alleged incidents of protected class discrimination or ethics violations at George Mason University. An asterisk (*) indicates a required field. Please fill out all requested information and click 'submit'. Information provided will be treated in the strictest confidence possible.

To provide information regarding alleged incidents of sexual or interpersonal misconduct, please click here to fill out our Title IX Report Form.

If you need a reasonable accommodation for a disability in order to participate in this process, please notify DEI and someone will assist you.

Name

Preferred Pronouns

GMU Affiliation *

Mailing Address *

Contact Phone *

Email Address *

TTY

Basis of Complaint and/or Alleged Discrimination *

For discrimination under Title VII of the Civil Rights Act of 1964 (definitions), please select the category or categories that best describe your allegation(s). Hold the CTRL (or CMD) key to select multiple.

For violations of the Conflict of Interest Rules or Mason Code of Ethics, please select the category that best describes your allegations from the drop-down menu, if applicable.

Type of Discrimination

Ethics Violations (if applicable)

Complaint

Respondent Name - Please provide the name of the person you are reporting *

Respondent GMU Affiliation *

Brief Account of Incident(s) *