Report an incident

Do not use this form to report events presenting an immediate threat to health or safety. If you require emergency assistance, please dial 911.

Please consider completing this form if you or someone you know has been subjected to sexual misconduct (sex discrimination, sexual violence (rape/sexual battery/sexual assault), sexual harassment, relationship violence (domestic violence and dating violence), stalking, harassment or violence based on sexual orientation, gender identity or gender expression, and other forms of sexually exploitative behavior and/ or if you or someone you know has been subjected to discrimination and or harassment based on a protected class (race, color, sex, religion, national origin, age, disability, genetic information, sexual orientation, veteran status, and retaliation).

More important than your decision to complete the form is the opportunity for WSSU to provide you with all of the support options even if you decide not to complete the form. Please contact the Office of EEO/Affirmative Action & Diversity 336-750-8759 for information about support options.

If you are unsure or would like to speak to someone about completing this form, please contact Aishah Casseus, EEO Officer & Title IX Coordinator, at 336-750-8758 or casseusa@wssu.edu

Your Information

Your information is optional, we will only use it if we need to contact you

Complainant Information

Respondent Information

Incident Information

What type of misconduct best fits the incident that occurred?
If you are unsure which category describe what you are reporting, please leave this blank.