Sexual Misconduct Report Form

Manhattan School of Music prohibits the actions which constitute sexual or gender harassment (or other forms of harassment based on a protected category), sexual assault, intimate partner violence and stalking. To make a report of any of these actions you are encouraged to go to Carol Matos, Vice President of Administration and Human Relations and MSM’s Title IX Coordinator, who is located in room A-427, and who can be reached at cmatos@msmnyc.edu. However, in order to offer multiple options for making a report, we have created this form as one of those options.

When you fill out this form you are not obligated to provide your name. Please be aware that if you do not provide your name you may limit MSM’s ability to respond to the information you share here, including MSM’s ability to take disciplinary action. However, even an anonymous report would allow us to put the person whose conduct allegedly violated our policy "on notice" and allow the School to make sure he or she understands what constitutes sexual misconduct under our Title IX/Sexual Misconduct Policy.

Person Filing Report (optional - see above)

First Name

Last Name

Phone Number

Incident Details (all information below is required)

Name(s) of person(s) alleged to have violated policy

Date(s) of Alleged Incident(s)

Location(s) of alleged incident(s)

Please provide a detailed description of the incident. Make sure to include dates, locations, names of witnesses if appropriate. Please describe any actions, anything pertinent that was communicated verbally, and any actions you or others have taken in response (you may attach additional sheets if necessary)

What action would you like MSM to take in response to this report?

I hereby certify that the foregoing information is true, correct, and complete to the best of my knowledge and belief.

Clear

Info For

Sexual Misconduct Report Form