* - required field
* I have read the definition of mistreatment posted on the "Information for Students" website
* Having read the definition of student mistreatment, I believe that I suffered mistreatment as a student that was outside the bounds of acceptable behavior.
Not certain that it was out of the bounds
* Please describe the behavior or incident
* Please choose the best descriptor of the inappropriate behavior (choose all that apply).
Publicly belittled or humiliated me
Asked to perform services (shopping, etc.)
Sexual Mistreatment (sexual advances)
Racial/ethnic/religious mistreatment (offensive remarks)
Racial/ethnic/religious mistreatment (lower grades)
Sexual orientation mistreatment (offensive remarks)
* The individual I hold responsible for this behavior is:
Allied Health Care Worker (Nurse, P.A., Social Worker, Clerk)
The name of the individual you are complaining about is: (optional)