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Report an Incident to the Office of Equity & Inclusion


By filling out this form, you are notifying the CSUDH Office of Equity and Inclusion about conduct related to discrimination, harassment, and/or retaliation (DHR), or sexual misconduct, dating violence, domestic violence, or stalking.

The Office of Equity & Inclusion will respond to this form by providing information about supportive measures, resources, and options to you and/or other involved parties. Filling out this form does not initiate the formal complaint process under the Title IX/DHR Policies and Procedures. To initiate this process, please review the policies and procedures and contact the Office of Equity and Inclusion at equity@csudh.edu or (310) 243-3492.


To report an emergency, please call the CSUDH Police Department by dialing (310) 243-3333 or 911. Submissions to this form may not be reviewed outside of normal business hours.

Background Information

You may remain anonymous in making this report. However, providing limited identifying information may also limit our ability to respond.

 
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If you are a student, please write student.
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If you are not a student or employee, leave this blank.
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Describe your role related to this incident.
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Please let us know what other departments/individuals are aware of this issue.
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If you do not know the exact date or there are multiple dates, you may clarify below in addl. info.
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Please let us know where this incident occurred, if you know.

Involved People

If you do not know a person's name, please include all the information you know about them. You may include additional information at the end of this form (i.e., a description or any identifying information that you have).



When selecting roles, please use the following:

Complainant: individual reporting an incident.

Victim/Survivor: individual to whom the conduct was directed.

Respondent: individual who is accused of an incident.

Witness: individual who observed the an incident.

*If you are the reporting party and you are not directly involved in the alleged incidnt, please do not include yourself.

Involved party 1

Information about the Incident

Please provide us with as much information as possible about the incident that you are reporting.

Please indicate the type of incident that you are providing information about:(Required)
You must make at least one selection.
Please select the status(es) that the incident occurred due to:
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Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission