Valley Grande Institute Information and Resolution Form

Valley Grande Institute Information & Resolution Form

Valley Grande Institute is committed to providing a safe, inclusive, and respectful environment for all students and employees. This form is intended to report incidents of discrimination, harassment, or any conduct that violates Title IX and EEO policies. All reports will be handled confidentially and investigated promptly.
PERSONAL INFORMATION
Name (Optional)

First NameLast Name
Email (Optional)
example@example.com
Phone Number (Optional)
Please enter a valid phone number.
Affiliation with Valley Grande Institute*

StudentFacultyStaffOther
INCIDENT INFORMATION
Date of Incident

MonthDayYear
Date
Time of Incident

Hour Minutes

AM/PM Option
Location of Incident:*
Type of Incident*

DiscriminationHarassmentSexual HarassmentRetaliationOther
INCIDENT DETAILS
Description of Incident: *
Please provide a detailed description of the incident, including what happened, who was involved, and any other relevant context.
Names of Individuals Involved: *
Please provide the names of all individuals involved in the incident, including any witnesses. Briefly describe each individuals role in the incident.
Were there any witnesses?*

YesNo
If there were witnesses to the incident, please provide the names and contact information for each. *
SUPPORTING INFORMATION
Have you reported this incident to any other authority or department within Valley Grande Institute?

YesNo
If yes to the question above, please provide detailed information. *
Please provide detailed information or describe any supporting documentation or evidence that is available. *
Please attach files if applicable.

Cancelof
IMPACT and RESPONSE
How has this incident affected you? *
Please describe any impact this incident has had on you personally, academically, or professionally.
What outcome are you seeking by reporting this incident? *
Please describe any specific actions or resolutions you are hoping for.
OTHER
Please provide any other information which you may feel is important.
CONFIDENTIALITY AND RETALIATION PROTECTION

Valley Grande Institute will make every effort to protect the confidentiality of the individuals involved. Retaliation against individuals who report incidents or participate in investigations is strictly prohibited.

Once completed, please submit this form online through our secure portal. If you have any questions or need additional assistance, please contact the Title IX Coordinator/EEO Officer at Valley Grande Institute by calling (956) 973-1945.
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Valley Grande Institute Information & Resolution Form