Equal Opportunity/Title IX Complaint Form

Please provide as much detail as possible. Asterisked and boldfaced items are required.

Reporting Person's Information


 (111) 111-1111
 (111) 111-1111

Incident Submission Information


Location where incident may have occurred (If 'Other' selected in 'CCC Location' field above):

Name of the individual I am filing this Equal Opportunity/Title IX Complaint against: *


Is the person that the complaint is being filed against an employee or a student? *


Provide the name(s) and telephone number(s) of any witness (es) to the incident.



Basis of Discrimination or Harassment (check all selections that may apply)  *


If "Other" selected in the "Basis of Discrimination" question above enter reason below:

Has an Incident Report been filed with a CCC Office of Safety and Security?  *


Has a police report been filed with the City of Chicago Police Department?  *


Description of Incident

The fact(s) of the incident which lead me to believe I was discriminated against or harassed were as follows (attach supporting documents, images or other materials). *

Supporting File Upload #1:  
Supporting File Upload #2:  
Supporting File Upload #3:  
Supporting File Upload #4:  
Supporting File Upload #5:  

Acceptable file formats include .doc, .docx, .png, .gif .jpg or .pdf less than 2MB (megabytes) each.

Requested remedy:

 (Enter Full Name)