General Complaints

Background Information

Please include your name and contact information on this form.

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Your full name:

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Firstname Lastname

Your role at the college:

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Are you faculty, staff, student, or a visitor?

Your phone number:

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Use campus extension or cell number (include area code)

Your email address:

Email address must be of a valid format.

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Use Durham Tech or ConnectMail account if you have one

Your ID number:

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Include all seven digits of your ID # (enter full DL #, if a visitor)

Nature of this report(Required):

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Urgency of this report(Required):

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Date of incident(Required):

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Time of incident:

Location of incident(Required):

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Specific location:

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Indicate room number/name (nearest room, if incident occurred in a hallway)

Involved Parties

List all known individuals involved, whether directly or indirectly (e.g., witnesses), and complete as many of the listed fields as you can. If the individual is a college visitor, please list a driver's license number in the block labeled "ID Number," if available.

If you have listed your information as the person submitting the report (reporting party), you do not need to re-enter your information here. Please be sure to include all seven digits of a Durham Tech ID in the "ID Number" field. Names should follow this format: FirstName LastName.

Note: "Responding Party" refers to the individual(s) about whom you are submitting this complaint.

Full Name

Select Gender

Select Role

ID number, if known

DOB (DD/MM/YYYY), if known

Phone number, if known

Email address, if known

Physical address, if known

Questions

Please provide a detailed description of your concern using specific, concise, objective language (who, what, where, when, why, and how). Include observed behaviors, without attempting to interpret them (e.g., report that the person was yelling and banging the wall, instead of saying the person was angry).(Required) This field is required.

Who have you already met with or spoken to, in an effort to address your concern? Please include name, role at the college/title, and date of meeting/conversation. This field is required.

What resolution are you seeking for your concern?(Required) This field is required.

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Select copy recipients

juneh@durhamtech.edu

Background Information

Involved Parties

Questions

Supporting Documentation

Select copy recipients

Submission