Student Affairs & Title IX Complaint

Please use this form to file a formal complaint for alleged violations of the Mount Saint Mary College Student Code of Conduct, Sexual Misconduct Policy, and/or Title IX complaints.

Sexual harassment is any unwelcome conduct that a reasonable person would find so severe, pervasive, and objectively offensive that it denies a person equal educational access. Reports of sexual assault, dating violence, domestic violence and stalking do not need to meet the definition of “severe, pervasive and objectively offensive.”

Mount Saint Mary College is committed to maintaining a campus environment in which all individuals are treated with respect and dignity. The College strictly prohibits unlawful discriminatory practices, including sexual harassment. If you believe that you have been subjected to discrimination, harassment (including sexual harassment), or retaliation, you are encouraged to complete this form and submit it to Student Affairs or Title IX Office. You are protected from retaliation against you for filing a formal complaint.

Contact Information:

Name (Leave blank if anonymous)

Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Phone Number

Complaint:

Name of the accused

Relationship to you, if any

Names of anyone else involved:

Add another party

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	#	Name	Relationship	Contact Information

Were there any witnesses to this specific event? If yes, please provide their names and contact information.

Date of Incident

Where did this incident take place?

If the behaviors occurred in more than one location, please provide the exact location where the conduct began and provide further details about additional locations in the space provided for a description of the incident.

Please describe the events that occurred

Please provide a description of the incident using concise and objective language. If you have a desired outcome, please provide details here.

Please describe the atmosphere prior to the incident

Please describe the atmosphere prior to the incident and the impact that this incident may have on the learning and/or workplace environment. If you do not feel there is an impact to the learning and/or workplace environment, you may leave this blank.

Is there any documentation or supporting evidence?

Is there any documentation or other evidence that supports your complaint? If so, please describe or attach copy of evidence.

Attachments

Signature:

I am willing to cooperate fully in the investigation of my complaint and provide whatever evidence the College deems relevant.

The information provided in this complaint is true and correct to the best of my knowledge

I am willing to cooperate fully in the investigation of my complaint and provide whatever evidence the College deems relevant.

I understand that submitting this form constitutes a legal signature agreeing to the terms and conditions and also certify that the provided information is complete, truthful, and accurate.

When the Submit button is clicked, this form will be sent electronically to the Director of Student Conduct and the Title IX Office. Please first read the Rights, Resources and Accommodations section that follows. Once this complaint is reviewed, you will be contacted by either Student Affairs and/or the Title IX Office, depending on the content of the complaint.

Submit

Rights, Resources, and Accommodation

For Mount students who experience Sexual Violence, including sexual assault; domestic, dating or, intimate partner violence, stalking or voyeurism All students have the right to:

1. Make a report to local law enforcement and/or state police.

2. Have disclosures of domestic violence, dating violence, stalking, and sexual assault treated seriously.

3. Make a decision about whether or not to disclose a crime or violation and participate in the judicial or conduct process and/or criminal justice process free from pressure by the institution.

4. Participate in a process that is fair, impartial, and provides adequate notice and a meaningful opportunity to be heard.

5. Be treated with dignity and to receive from the institution courteous, fair, and respectful health care and counseling services, where available.

6. Be free from any suggestion that the reporting individual is at fault when these crimes and violations are committed or should have acted in a different manner to avoid such crimes or violations.

7. Describe the incident to as few institutional representatives as practicable and not be required to unnecessarily repeat a description of the incident.

8. Be protected from retaliation by the institution, any student, the accused and/or the respondent, and/or their friends, family and acquaintances within the jurisdiction of the institution.

9. Have access to at least one level of appeal of a determination.

10. Be accompanied by an advisor of choice who may assist and advise a reporting individual, accused, or respondent throughout the judicial or conduct process including during all meetings and hearings related to such process; and

11. Exercise civil rights and practice of religion without interference by the investigative, criminal justice, or judicial or conduct process of the institution.

Reporting and Response

Individuals wishing to report incidents of sexual assault, domestic violence, dating violence, and/or stalking have the right to pursue more than one of the reporting options below, or to choose not to participate in any of the options below. You may choose to:

Report the incident confidentially to a college official, including professional and pastoral counselors, who by law may maintain confidentiality, and can assist in obtaining support, counseling, and protective services:

Elizabeth Bruno LMHC, Counseling Services, Elizabeth.Bruno@msmc.edu, 845-569-3433
Fr. Gregoire Fluet, Chaplain, Director of Campus Ministry Gregoire.Fluet@msmc.edu, 845-569-3154

Report the incident to other non-professional counselors, administrators and staff who can offer privacy and can assist in obtaining direction, suggestions, or referrals to services that may be helpful:

Deirdre Pettus BSN, RN, CRRN, Director of Health Services, Deirdre.Pettus@msmc.edu, 845-569-3153
Alisha McCorvey EdD, LCSW-R, Assistant VP for Students, alisha.williams-mccorvey@msmc.edu, 845-569-3641

Disclose confidentially the incident and obtain services from the New York State or county hotlines:

Fearless! (Formerly Safe Homes) (888) 503-4673 (HOPE)
Mental Health Association of Orange County (Rape Crisis) (800) 832-1200

Office for the Prevention of Domestic Violence and presented in several languages: http://www.opdv.ny.gov/help/index.html (or by calling 1-800-942-6906)

ON Campus Resources:

Matthew T. Byrne, Title IX Coordinator, matthew.byrne@msmc.edu (845) 569-3597
Margaret Kemp, Deputy Title IX Coordinator, Margaret.kemp@msmc.edu 845-569-3638
Amy Weit, Director of Residence Life and Director of Student Conduct, amy.weit@msmc.edu (845) 569-3732
Richard Algarin, Director of Security & Safety, richard.algarin@msmc.edu (845) 569-3598

File a criminal complaint with Campus Security, local law enforcement, and/or state police:

Campus Security: 845-569-3200
City of Newburgh Police Department: 845-561-3131
New York State Police: 844-845-7269 (Campus Sexual Assault Victims Unit)

Disclose, if the accused is a faculty member, staff member, or administrator of the College, the incident to the College’s Human Resources authority, or the right to request that a confidential or private employee assist in reporting to the appropriate human resources authority; receive assistance from appropriate College representatives in initiating legal proceedings in Family Court or civil court.

Withdraw your complaint or involvement from the College process at any time.

A complainant wishing to file charges may choose to do so either through the College’s disciplinary process, criminally, or both.

These are just some of the Rights, Resources, and Response options available to you as a student. For a full list, refer to the MSMC Student Handbook located on the portal in Student Resources.