Purpose of Form This form allows any member of the Juilliard community to report any conduct potentially prohibited under Juilliard’s Non-Discrimination and Harassment Policy, specifically bias-related conduct, discrimination, harassment, and hate/bias conduct. After Submission Once you click submit, your report will be transmitted directly to Juilliard’s Non-Discrimination and Title IX Officer. Upon receipt of this form, the Non-Discrimination and Title IX Officer will reach out to you promptly to discuss all of your rights and options under the Policy. Anonymous Reporting Any member of the Juilliard community has the right to make an anonymous report. It is important to note that depending on the level of information available about the incident or the individuals involved, anonymous reporting may reduce the School’s ability to respond or pursue appropriate action. Whatever your decision, the Non-Discrimination and Title IX Officer or any other Juilliard officials designated in the Policy are available to provide guidance and support in making your report. Additional Resources Free and confidential counseling is available through Juilliard Counseling Services (for students), Employee Assistance Program (for employees), and NYC Well (24/7 talk-text-chat). Reporting Party Full Name Preferred Name Preferred Pronouns - Select -she/herhe/himthey/themother Other preferred pronouns Preferred Communication Method Phone Email Email Address Phone Number Alleged Incident Information Full Name of Accused Party Status of Accused Party - Select -StudentFacultyStaffOther Other status Full Names/Status of Any Additional Accused Parties Description of Alleged Incident(s) Please describe the incident(s) in as much detail as you are able. It is helpful to address the following: who was involved and/or present what took place when it occurred, including the date where it occurred, including specifics about location any details about how it occurred Potential Witness(es)Witness 1 Full Name of Witness 1 Status of Witness - Select -StudentFacultyStaffOther Other status Relationship to Witness (e.g. friend, acquaintance) Phone Number Email Description of Witness’ Knowledge Add Additional Witness Yes No Witness 2 Full Name of Witness 2 Status of Witness - Select -StudentFacultyStaffOther Other status Relationship to Witness (e.g. friend, acquaintance) Phone Number Email Description of Witness’ Knowledge Add Additional Witness Yes No Witness 3 Full Name of Witness 3 Status of Witness - Select -StudentFacultyStaffOther Other status Relationship to Witness (e.g. friend, acquaintance) Phone Number Email Description of Witness’ Knowledge Add Additional Witness Yes No Witness 4 Full Name of Witness 4 Status of Witness - Select -StudentFacultyStaffOther Other status Relationship to Witness (e.g. friend, acquaintance) Phone Number Email Description of Witness’ Knowledge Add Additional Witness Yes No Witness 5 Full Name of Witness 5 Status of Witness - Select -StudentFacultyStaffOther Other status Relationship to Witness (e.g. friend, acquaintance) Phone Number Email Description of Witness’ Knowledge Additional Information Electronic Communications and Other Documents If applicable, please describe any electronic communications (e.g. texts, emails, social media messages, etc.) and other documents that you have relating to this incident. You may upload copies of the communications here. Attachment 1 Files must be less than 5 MB.Allowed file types: jpg jpeg png txt pdf doc docx mov mp3. Attachment 2 Files must be less than 5 MB.Allowed file types: jpg jpeg png txt pdf doc docx mov mp3. Attachment 3 Files must be less than 5 MB.Allowed file types: jpg jpeg png txt pdf doc docx mov mp3. Previously Reported If you have previously reported this incident(s) to the School or local law enforcement, please indicate to whom and when reported.
