Equal Opportunity Reporting Form

Background Information

Your full name:

Your position/title:

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What is your role at/or relationship to the University of Maine System?

Your phone number:

Your email address:

Your physical address:

Nature of report:(Required):

This field is required.

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How have you been affected?

Date(s) of incident(s):(Required):

This field is required.

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Please be as specific as possible.

Time of incident::

Location of incident(Required):

This field is required.

Specific location::

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Office number, parking lot, etc.

Involved Parties

I am filing a complaint regarding the following individual(s):

Name

Select Role

ID Number (if known)

Their phone number (if known)

Their email address (if known)

Questions

Supporting Documentation

Please attach/upload any supporting documents, emails, photos, screen shots, etc. that you feel are relevant. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Email me a copy of this report

Background Information

Involved Parties

Questions

Supporting Documentation

Submission