Discrimination Report Form

Reporting

Allegations of discrimination may be made by any person regardless of whether or not the person reporting is the alleged victim of conduct that could constitute discrimination. Reports can be made using the online reporting form or by visiting, calling, or emailing the Office for Institutional Equity & Compliance using the information provided below.

Once an allegation of discrimination is received, an Equity Investigator will contact the Complainant and explain the requirements and process for filing a formal complaint, the jurisdiction requirements, and possible supportive measures.

Please read the Discrimination Complaint and Investigation Procedures Policy for more information about reporting and the complaint process.

Legal Affairs & Compliance
Carrington 205
417-836-4252

Equity@MissouriState.edu

To report an allegation of discrimination now, please complete the online form below.

Online Reporting Form

If you receive an error after clicking the submit button, please send your discrimination complaint to Equity@MissouriState.edu.

Please don't fill out this input box.

Complainant Information

Complainant means an individual alleged to be the victim of conduct that could constitute Discrimination.

Personal pronouns

First name*

Middle name

Last name*

BearPass

Phone number*

Email address*

Street address

City

State

Zip code

University affiliation

Race or ethnicity

Respondent Information

Respondent means an individual alleged to be the perpetrator of conduct that could constitute Discrimination.

Relationship to complainant*

First name*

Middle name

Last name*

BearPass

Phone number

Email address

Street address

City

State

Zip code

University affiliation

Race or ethnicity

Third party or referral

Please provide your information below if you are making a report on behalf of another person.

Relationship to complainant

Personal pronouns

First name

Middle name

Last name

BearPass

Phone number

Email address

Street address

City

State

Zip code

University affiliation

Race or ethnicity

Incident Information

Please indicate the nature of discrimination by selecting one or more options from the drop-down list*

Location of the incident*

Date and time of the incident*

Summary of the incident*

Was this incident reported to anyone outside the Office for Institutional Equity & Compliance?*

If yes, to whom and when was it reported?

Acknowledgement*

I acknowledge this form was completed in good faith and the information it contains is true to the best of my knowledge.

Age
Ancestry
Community relations
Disability status
Employee relations
Equal pay
Gender
General unfair hiring practices
Housing
Marital status
National origin
Parental status
Political affiliation
Pregnancy
Race or color
Religion
Retaliation
Sexual orientation
Student relations
Veteran status
Other