Sexual Misconduct Complaint Form Header Image

The City University of New York
Sexual Misconduct Allegation Form


This form may be used by reporting individuals or complainants, including employees, students and visitors, who wish to file a complaint of sexual harassment, gender-based harassment and/or sexual violence pursuant to CUNY’s Policy on Sexual Misconduct. CUNY’s policy prohibits retaliation against any person who reports sexual misconduct, assists someone making such a report, participates in any manner in an investigation or resolution of a sexual misconduct complaint, seeks interim or supportive measures or accommodations pursuant to CUNY’s Policy on Sexual Misconduct, or opposes in a reasonable manner an act or policy believed to constitute sexual misconduct. For additional information, please visit the QCC Title IX webpage.

Part A

Name*
Today's Date
Status at Queensborough Community College*
Home Address*
1. Have you previously filed a complaint? *
2. Have you filed this allegation with a federal, state or local law enforcement/agency? *
If no, why? *
If you chose other, please state the reason.
3. Do you have an order of protection (OOP) in this matter? *
If yes, is this order permanent or temporary?*
4. Was OOP given to your campus Public Safety Office?*

Part B: Summary of Sexual Misconduct Allegation

1. Alleged sexual misconduct took place on or about:*
:  
Is the alleged sexual misconduct continuing?*
3. Is the Respondent a CUNY*
If not, what is respondent’s relationship to you?
7. Please preserve any evidence in your possession that may be used as part of the investigation of this matter. Evidence may include but it not limited to: (i.e Facebook, Instagram, Snapchat, TikTok, Twitter, Whatsapp, photos, other documents, etc.)*
9. I would like this allegation(s) investigated by the Title IX Office.*
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