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Discrimination Form
In compliance with Title VI of the Civil Rights Act of 1964, Title VII of the Civil Rights Act of 1964, Title IX of the Education Amendments of 1972, Section 504 of the Rehabilitation Act of 1973, and other applicable laws, Lincoln Memorial University does not discriminate in its admissions, programs, and activities on the basis of age, color, creed, disability, ethnic/national origin, sex, gender, military status, pregnancy, race, religion, sexual orientation, and genetic information.
The Institutional Compliance Office oversees the University’s compliance with federal law and handles all complaints of discrimination. This form may be used to file a complaint of discrimination or harassment with the Lincoln Memorial University Office of Institutional Compliance.
Name of Person Reporting:
First
Last
Phone Number:
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Email:
Status (check all that apply):
Student
Staff
Faculty
Graduate Assistant
Applicant
Visitor
Vendor
I.
Complainant Information (the individual who may identify as the victim)
Name of Person Reporting:
First
Last
Phone Number:
###
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Email:
Status (check all that apply):
Student
Staff
Faculty
Graduate Assistant
Applicant
Visitor
Vendor
II.
Respondent Information (the individual(s) who may be identified as the accused)
Name of Person Reporting:
First
Last
Phone Number:
###
-
###
-
####
Email:
Status (check all that apply):
Student
Staff
Faculty
Graduate Assistant
Applicant
Visitor
Vendor
III.
Basis of Complaint (check all that apply)
Race
Color
National Origin
Religion
Veteran Status
Age
Disability
Sex
Sexual Harassment
Marital Status
Pregnancy
Sexual Orientation
Gender
Gender Identity
IV.
Select the risk level you believe most likely represents this incident:
Emergent/High Risk
Urgent/Risk
Controlled/Low Risk
General Report/No Immediate Risk
V. Please provide a detailed statement of incident(s) and describe the specific act(s). Please include date(s), time(s), location(s), and the names of any witnesses that have information related to the incident(s).
VI. Statement of action taken (for example, “contacted Campus Police” or “sought medical treatment”)
