UNIVERSITY OF UTAH
OFFICE OF EQUAL OPPORTUNITY & AFFIRMATIVE ACTION
POLICY 5-210, DISCRIMINATION AND SEXUAL HARASSMENT COMPLAINT POLICY -- COMPLAINT FORM
____________________________________________________________________________________________
NOTE: This form is not viewed as an official charge unless it is signed and submitted to the OEO/AA at the address listed on the
following page. It is the responsibility of this office to investigate and/or mediate all cognizable claims of discrimination and sexual
harassment, which includes allegations of sexual misconduct.
1. __________________________________________________________________________________________
Name
Daytime Telephone
Cell/Home Telephone
__________________________________________________________________________________________
Home Address
City
State
Zip Code
__________________________________________________________________________________________
If applicable: Campus Address
Campus Telephone
UNID#
2. Please indicate your status at the time of the alleged discrimination. (Check all that apply)
_____Faculty
____Staff
_____Applicant
_____ Visitor
_____Patient
____ Participant _____Student
_____Other
3. Nature of discrimination. (Check all that apply)
_____Race/Ethnicity
_____National Origin
_____Color
_____Religion
_____Disability or Disability Status
_____Age
_____Veteran’s Status
_____Genetic Information
_____Sex
_____Pregnancy
_____Sex Orientation
_____Gender Identity/Expression
_____Sexual Misconduct (See pgs. 2 & 3 for definitions)
_____Sexual Harassment
_____Sexual Assault
_____Sexual Exploitation
_____Stalking
_____Domestic Violence
_____Dating Violence
_____Retaliation (See pg. 6)
4. Please indicate your choice of resolution process. Note that selecting the Mediation/Negotiation Process does not limit you from
choosing the Investigation Process at a later time. Please note that Mediation/Negotiation is not a resolution process offered for allegations
of Sexual Assault, as the University is obligated to investigate such claims.
_____Investigation
_____Mediation/Negotiation
5. Please provide information you have pertaining to the individual(s) you feel have discriminated against/sexually harassed you. (If there
is more than one individual, list all who are applicable on a separate sheet.)
______________________________________________________________________________________________________
Name
Status (Student, Faculty, Staff, Other)/Title
Telephone
___________________________________________________________________________________________
Department
Department Address
Date of last alleged discriminatory or retaliatory act: ___________________________
6. On a separate sheet of paper, please provide the following information concerning your complaint:
·
Briefly explain how you and/or others were treated differently than similarly situated individuals and list dates of
occurrences.
·
Provide the names of the individual(s) treated differently. Include telephone numbers and position titles if known.
·
Identify the individual(s) who may have witnessed the alleged discriminatory action or who could provide information
relevant to the issues raised in your complaint. Include telephone numbers if known.
·
Describe other actions you have taken, if any, in attempting to resolve the situation.
·
Describe the actions you feel are necessary to remedy the situation.
·
List any internal grievance processes you have initiated or may initiate regarding your complaint.
·
If you are alleging discrimination due to disability, please describe your disability and how it substantially limits you
·
Depending on the nature of your disability, this office may require medical documentation.
I affirm that I have read the above charge and it is true to the best of my knowledge and belief.
__________________________________________________________________________________________________
Name of Charging Party
Signature
Date
UNIVERSITY OF UTAH
POLICY 5-210 COMPLAINT FORM
DEFINITIONS
For purposes of Policy 5-210 complaints, Sexual Misconduct” includes a range of behaviors that are sex-based and includes sexual
harassment, gender-based harassment, stalking, dating or domestic violence, and sexual assault. Acts of Sexual Misconduct may
also constitute a crime, which should be independently reported to the appropriate law enforcement agency and may result in
criminal prosecution or civil liability. The fact that an allegation of sexual misconduct is being investigated by a law enforcement
agency will not constrain or prevent the University from investigating the matter concurrently, pursuant to its internal policies.
A.
“Sexual Harassment” means unwelcome sexual advances, requests for sexual favors, and other verbal or
physical conduct of a sexual nature when:
1. Submission to such conduct is made either explicitly or implicitly a term or condition of an
individual's employment, education, living environment or participation in a university activity;
2. Submission to or rejection of such conduct by an individual is used as the basis for or a factor in
decisions affecting that individual's employment, education, living environment, or participation in a
university activity; or
3. Such conduct has the purpose or effect of unreasonably interfering with an individual's employment
or educational performance or creating an intimidating, hostile, or offensive environment for that
individual's employment, education, living environment, or participation in a university activity.
B.
“Sexual assault” is actual or attempted sexual contact with another person without that person’s consent. Sexual
assault includes, but is not limited to:
1.
Intentional touching of another person’s intimate parts without that person’s consent; or
2.
Other intentional sexual contact with another person without that person’s consent; or
3.
Coercing, forcing, or attempting to coerce or force a person to touch another person’s intimate
parts without that person’s consent; or
4.
Rape is penetration, no matter how slight, of (1) the vagina or anus of a person by any body
part of another person or by an object, or (2) the mouth of a person by a sex organ of another
person, without that person’s consent. See Utah Code:
o Utah Code 76-5-402, Rape
o Utah Code 76-5-402.2, Object Rape
o Utah Code 76-5-402.3, Sodomy-Forcible Sodomy
o Utah Code 76-5-403.1, Forcible Sexual Abuse
o Other definitions of criminal sex offenses contained within the Utah Code may be
accessed at: Utah Criminal Code, Offenses Against the Person, Sex Offenses (76-5-4)
C. “Sexual exploitation” occurs when a person takes sexual advantage of another person for the benefit of anyone other
than that person without that person’s consent. Examples of behavior that could rise to the level of sexual exploitation
include:
1.
Prostituting another person;
2.
Recording images (e.g., video, photograph) or audio of another person’s sexual activity,
intimate body parts, or nakedness without that person’s consent;
3.
Distributing images (e.g., video, photograph) or audio of another person’s sexual activity,
intimate body parts, or nakedness, if the individual distributing the images or audio knows or
should have known that the person depicted in the images or audio did not consent to such
disclosure and objects to such disclosure; and,
4.
Viewing another person’s sexual activity, intimate body parts, or nakedness in a place where
that person would have a reasonable expectation of privacy, without that person’s consent,
and for the purpose of arousing or gratifying sexual desire. See Utah Code 76-5b, Sexual
Exploitation Act and Utah Code 76-9-7-702.7, Voyeurism offenses
C.
"Consent" means affirmative and freely given permission to sexual activity. A person can express consent, or
lack of consent, through words or conduct. Past consent to sexual activity with another person does not imply
ongoing future consent with that person or consent to the same activity with another person. Consent is not
given where the perpetrator overcomes through the application of force, violence, concealment or surprise. A
person has not consented when the perpetrator knows that the person is incapacitated, unconscious, unaware that
the act is occurring, or is physically unable to resist. Individuals under the age of 14 cannot consent to sexual
activity. A person has not consented where the perpetrator intentionally impairs the individual by administering
any substance without the person’s knowledge. For a non-exhaustive list of situations in which consent has not
been given, see Utah Code Sec. 76-5-406, Sexual offenses against the victim without the consent of the victim.
D.
"Domestic violence" means any offense involving violence or physical harm or threat of violence or physical
harm, or any attempt, conspiracy, or solicitation to commit a criminal offense involving violence or physical
harm when committed by one cohabitant against another. Domestic violence also means commission or attempt
to commit any of the offenses listed in Utah Code 77-36-1, Cohabitant Abuse Procedures Act, by one cohabitant
against another, including but not limited to assault, harassment, kidnapping, sexual offenses, stalking, or
violating a protective order.
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UNIVERSITY OF UTAH
POLICY 5-210 COMPLAINT FORM
DEFINITIONS, cont.
E.
F.
"Dating violence" means any criminal offense involving violence or physical harm, or threat of violence or
physical harm, when committed by a person against a dating partner of the person, or any attempt, conspiracy, or
solicitation by a person to commit a criminal offense involving violence or physical harm against a dating partner
of the person. See Utah Code 78B-7-4, Dating Violence Protection Act.
"Stalking" means intentionally or knowingly engaging in a course of conduct directed at a specific person that
the actor knows or should know would cause a reasonable person to fear for his or her own safety or the safety of
a third person, or to suffer other emotional distress. Stalking is also the intentional or knowing violation of a
stalking injunction. See Utah Code 76-5-106, Stalking – Definitions – Injunction – Penalties.
FILING OPTIONS
I. To file a complaint of discrimination, sexual harassment (including sexual misconduct or violence), or retaliation, under
University of Utah Non-Discrimination Policy:
A complaint of discrimination, sexual harassment, and/or retaliation must be filed with the Office of Equal Opportunity and
Affirmative Action within 120 calendar days of the date of most recent alleged discriminatory act(s) or event(s).
University of Utah
Office of Equal Opportunity & Affirmative Action
201 S. Presidents Circle, Room 135
Salt Lake City, UT 84112
Telephone: 801-581-8365
TDD: 801-587-3374
Fax: 801-585-5746
Title IX Coordinator:
The University has designated the following individual as its Title IX Coordinator, who can be contacted at the address and
numbers above:
Director, Office of Equal Opportunity and Affirmative Action
ADA/Section 504 Coordinator:
The University has designated the following individual as its ADA/Section 504 Coordinator, who can be contacted at the
address and numbers above:
Director, Office of Equal Opportunity and Affirmative Action
II. To file a complaint regarding discrimination, sexual harassment, or retaliation with a regulatory state or federal agency, please
see the agency information below. For information about the time frames in which complaints must be filed, please contact the
relevant agency.
A. Regarding Education:
United States Department of Education
Office for Civil Rights– Region VIII
Cesar E. Chavez Memorial Building
1244 Speer Boulevard, Suite 310
Denver, Colorado 80204-3582
Telephone: 303-844-5695
FAX: 303-844-4303
Online complaint portal: http://www2.ed.gov/about/offices/list/ocr/docs/howto.html
Website: www.ed.gov/about/offices/list/ocr/index.html
Complaints regarding: Title VI of the Civil Rights Act of 1964, Title IX of the Education Amendments of 1972, Section
504 of the Rehabilitation Act of 1973, Title II of the Americans with Disabilities Act, Age Discrimination Act of 1975.
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UNIVERSITY OF UTAH
POLICY 5-210 COMPLAINT FORM
FILING OPTIONS, cont.
B. Regarding Employment:
1.
State Agency:
Utah Anti-Discrimination and Labor Division (UALD)
160 East 300 South, 3rd floor
P.O. Box 146630
Salt Lake City, Utah 84114-6630
Telephone: 801-530-6801
TDD: 801-530-7685
www.laborcommission.utah.gov
Individual complaints regarding: Utah Anti-Discrimination Act of 1965, Title VII of the Civil Rights Act of
1964, as amended, Age Discrimination in Employment Act of 1967, as amended, and the Americans with
Disabilities Act of 1990.
2.
Federal Agencies:
a. Equal Employment Opportunity Commission
Phoenix District Office
3300 North Central Avenue, Suite 690
Phoenix, AZ 85012
Telephone: 602-640-5000
TDD: 602-640-5072
Fax: 602-640-5071
www.eeoc.gov
Complaints regarding: Title VII of the Civil Rights Act of 1964, The Pregnancy Discrimination Act, Age
Discrimination in Employment Act of 1967, as amended (ADEA), Equal Pay Act of 1963, Title I of the
Americans with Disabilities Act Amendments Act of 2008, Sections 501 and 505 of the Rehabilitation Act of
1973 and Section 102 and 103 of the Civil Rights Act of 1991, the Genetic Information Nondiscrimination Act of
2008 (GINA)
b.
U.S. Department of Labor
Office of Federal Contract Compliance Programs (OFCCP)
Federal Building, Room 840
525 South Griffin Street
Dallas, TX 75202
Telephone: (972)850-2550
Fax: (972)850-2552
Online complaints: OFCCP-SW-CC4@dol.gov
Website: www.dol.gov/ofccp
Executive Order 11246 (Equal Employment and Affirmative Action)
Americans with Disability Act Amendments Act, of 2008
Section 503 of the Rehabilitation Act of 1973
38 USC 4212 – The Vietnam Era Veterans’ Readjustment Assistance Act of 1974
Uniformed Service Employment and Re-employment Rights Act (USERRA)
Online complaint portal: http://www.dol.gov/elaws/vets/userra/ee_disc.asp
c.
Veteran’s Employment and Training Service
140 East 300 South, Room 209
Salt Lake City, UT 84111
Telephone: 801-524-5703
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UNIVERSITY OF UTAH
POLICY 5-210 COMPLAINT FORM
FILING OPTIONS, cont.
C. Regarding health care, human services, and activities (Patients and Participants):
U.S. Department of Health & Human Services
Office for Civil Rights, DHHS – Region VIII
999 18th Street, Suite 417
Denver, Colorado 80202
Telephone: 303-844-2024
Fax: 303-844-2025
TDD: 303-844-3439
Online complaint portal: https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
Website: www.hhs.gov/ocr
Complaints regarding: Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, as
amended, the Age Discrimination Act of 1975, Title II of the Americans with Disabilities Act (ADA), and the
Community Service Assurance provisions of the Hill-Burton Act
D. Regarding Housing (Residents of dorms and family student housing)
1.
Utah Anti-Discrimination and Labor Division (UALD)
160 East 300 South, 3rd floor
Salt Lake City, Utah 84114-6630
Telephone: 801-530-6801
TDD: 801-530-7685
www.laborcommission.utah.gov
Complaints regarding: Utah Fair Housing Act of 1993, as amended.
2. United States Department of Housing and Urban Development (“HUD”)
1670 Broadway, 25th floor
Denver, Colorado 80202-4801
Telephone: (303)672-5440
Email: (303)672-5004
Online complaint portal:
http://portal.hud.gov/hudportal/HUD?src=/program_offices/fair_housing_equal_opp/online-complaint
Complaints regarding: Title VI of the Civil Rights Act of 1964, as amended, Title VIII of the Civil Rights
Act of 1968 (Fair Housing Act), Section 504 of the Rehabilitation Action of 1973, as amended, Title II of
the Americans with Disabilities Act of 1990, Age Discrimination Act of 1975, Title IX of the Education
Amendments Act, and Architectural Barriers Act of 1968.
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UNIVERSITY OF UTAH
POLICY 5-210 COMPLAINT FORM
NOTICE OF RETALIATION PROHIBITED
University of Utah policy and state and federal law prohibit retaliation against any individual who files a
complaint, opposes illegal discrimination or harassment or assists or participates in any manner in a discrimination
investigation or proceeding conducted by the University of Utah or a federal or state enforcement agency.
Title IX of the Education Amendments Act of 1972
Prohibits discrimination on the basis of sex in any education program or activity receiving Federal financial assistance. Title IX provides
protection from and prohibits retaliation against a person who has filed a complaint or who assists in a discrimination complaint
investigation.
Section 704 (a) of Title VII of the Civil Rights Act of 1964, as amended, states:
It shall be an unlawful employment practice for an employer to discriminate against any of his [or her] employees or applicants for
employment, for an employment agency, or joint labor-management committee controlling apprenticeship or other training programs, to
discriminate against any individual, or for a labor organization to discriminate against any member thereof or applicant for membership,
because he [or she] has opposed any practice made an unlawful employment practice by this sub-chapter, or because he [or she] has made a
charge, testified, assisted, or participated in any manner in an investigation, proceeding, or hearing under this sub-chapter.
Section 504 of the Rehabilitation Act of 1973 and the Americans With Disabilities Act Amendments Act of 2008
Protects individuals who exercise their rights under Section 504 of the Rehabilitation Act of 1973 or the ADA are protected from
retaliation. Any individual who has filed for an accommodation or has complained, testified or participated in any manner in the
investigation of any complaint shall not be intimidated, threatened, coerced, or discriminated or retaliated against in any way.
STATEMENT OF UNDERSTANDING
In addition to conducting University policy violation investigations, the OEO/AA is responsible for investigating
and responding to complaints received from external enforcement agencies. When a person files a complaint with
the OEO/AA and/or an external enforcement agency, relevant information provided or obtained during the
investigation of either the internal or external complaint may be used by OEO/AA in its investigative report or
response.
It is the responsibility of all parties to a complaint to ensure that the OEO/AA has a current address and contact
number on file. All correspondence to parties will be mailed via the campus mail system or by regular US mail to
the address(es) provided by the respective parties, or to the party representative in the case of multiple complaints.
Documents mailed by US mail will be presumed to have been received three business days after the date of mailing
if the address is in state or five business days if the address is out of the state.
If you have filed, or intend to file, other internal grievances related to these issues, the processing of the grievances
may be put on hold pending resolution of your Policy 5-210 complaint if the issues raised cannot be clearly
separated.
By signing below, you affirm that you have been informed of the procedures, time constraints and external avenues
of redress that are available to you.
_______________________________
Name
_______________________________________
Signature
Email address, to be used in lieu of mail delivery: ___________________________________
***********
End of form
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_________
Date