Intake Form

This form provides the Office for Diversity, Equity, and Inclusion (DEI) at George Mason University with basic information regarding an alleged incident or incidents of protected class discrimination. An asterisk (*) indicates a required field. If a reasonable accommodation or other assistance is necessary to participate in this process, please notify DEI.

Please fill in all requested information and click 'submit'. Information provided will be treated in the strictest confidence possible and only used as necessary to process this complaint.

Note that complaints of Sexual Assault, Quid Pro Quo Sexual Harassment, Hostile Environment Sexual Harassment, Sexual Exploitation, Dating Violence, Domestic Violence and Stalking, as well as related complicity and retaliation are covered by a separate policy and process. To provide information regarding alleged incidents of sexual or interpersonal misconduct or other prohibited conduct, please contact our Title IX team (titleix@gmu.edu) or fill out a Title IX Report Form.

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) *

Intake Form

Escape

Basis of Complaint and/or Alleged Discrimination *

Complaint