Please use this form to file a complaint of sexual misconduct or any other type of discrimination based upon race, gender and/or gender identity or expression, marital status, color, creed, religion, ancestry, age, national origin, ethnicity, disability, veteran or military status, pregnancy, sex, sexual orientation, marital status, citizenship status, status as a victim of domestic violence, stalking or sex offenses, retaliation, or any other legally prohibited basis in accordance with Federal, State and City Laws.
Completion of this form will initiate a complaint with the Office of Compliance and Diversity (“OCD”) at Hostos which is an internal unit charged with investigating allegations of discrimination and sexual misconduct at the College in accordance with the CUNY Policy on Equal Opportunity and Non-Discrimination Policy and the CUNY Sexual Misconduct Policy. Information is shared with additional parties on a need to know basis depending on the facts.
IMPORTANT NOTICE: The Hostos Website is currently undergoing maintenance and therefore the online form is currently unavailable. Complaints must be sent via email to POliveri@hostos.cuny.edu and JJones@hostos.cuny.edu and must include the following information:
Type(s) of Complaint (Discrimination, Harassment, Sexual Misconduct)
Date(s) of Indicent
Name of respondant (person complaint is against)
Alleged discrimination is based on (select all that apply)
Race or Color
Sex
Sexual Orientation
Sexual Harassment
Stalking
Sexual Assault
Pregnancy
Ancestry
Military or Veteran Status
Religion/Creed
Genetic Information
Gender Identity
Disability
Age
Gender
Marital/Partnership Status
Retaliation
Domestic Violence
Alienage or Citizenship Status
Other
If Other, enter alleged discrimination
Summary of allegations
Please identify any witnesses or other individuals with information regarding your allegations
You may also provide us with the following optional information:
Location of Incident
Was the act Commited Online?
How were you affected (directly, witness, third-party non-witness)?
Status of Respondant/Person Complaint is Against (student, faculty, staff, other)
If other, please enter their status
Have you previously made a complaint with OCD and/or reported your concerns to a supervisor?
Have you reported your complaint with any other office on campus? If yes, where?
Have you filed this charge with a federal, state or local government agency/court? If yes, with which agency/court?
What action, if any, are you requesting?
In the interim what actions can the college do to assist you? Are you requesting interim measures? For example, course related extensions or adjustments or modifications to your work or course schedule?
Your Name
Your Address (including city, state, zipcode)
Your Telephone (please mention if home phone, work phone and/or cellphone)
Hostos Email Address
Personal Email Address
Employee ID and/or Student ID
Would you like to remain anonymous?