CPDD Misconduct/Harassment Reporting Form | College on Problems of Drug Dependence

Name

First

Last

Email

Confirm Email

Note, we will accept anonymous complaints, but without the identity of the alleged victim or complainant, it may be difficult to corroborate the conduct alleged

Date of Incident *

Time of Incident *

Location of Incident *

Narrative of Incident *

Please provide a narrative of the incident with as much detail as possible (e.g., date, times, nature of the incident, comments made, name of alleged offender if available).

Names of Any Witnesses

Please add any additional information, e.g., emails, notes, names of witnesses.