Report A Problem, Incident, or Concern

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Please use this form to inform the Central Fraternity Office of Theta Delta Chi of any concerns you may have about Theta Delta Chi, or members of Theta Delta Chi, on the local or international level. If you are concerned that someone is in danger, a crime is being committed, local laws or ordinance is being violated, or an emergency is occurring, please contact your local authorities and utilize emergency services (such as 911) immediately. This form will help us investigate but may not result in immediate action or help that local law enforcement can provide.

What is the nature of your concern? *

Discrimination

Sexual Harassment

Sexual Assault

Hazing

A Health or Safety Concern

Possible Criminal Activity

Other:

Required

Person Making The Report

We request that people making a report share their contact information with us so that we may follow up. We can promise that we will not directly share your information with the person or persons that are the subject of the complaint. We may be obligated to share the information with University and Law enforcement officials. Anonymous Hazing concerns can be made to the hazing hotline at 1-888-668-4293.

Full Name *

Phone *

E-mail *

I am ...... *

A member of the Charge

A concerned observer

A member of the community

A Survivor of Assault or Harassment that is the subject of this complaint

A friend, acquaintance, or family member of someone who is A Survivor of Assault or Harassment that is the subject of this complaint

A Survivor of Hazing that is the subject of this complaint

A friend, acquaintance, or family member of someone who is A Survivor of Hazing that is the subject of this complaint

Someone who experienced discrimination that is the subject of this complaint

A friend, acquaintance, or family member of someone who experienced discrimination that is the subject of this complaint

A direct witness to something objectionable

Other:

Required

To the best of your ability please describe your concern. Thank you for sharing with us, please be as thorough as you are comfortable with. Any information will help us investigate. *

Please provide the location where the concern or incident took place

Where did the concern or incident take place? *

On Campus

Off Campus

At a Theta Delta Chi run or owned property

Neither on campus or on property run or owned by Theta Delta Chi

I am not sure

Other:

Required

Please share any other relevant information about the location of the concern or incident *

Does the concern or incident involve a member of Theta Delta Chi, or a location owned or run by Theta Delta Chi? *

Yes

I don't know

If you know, please share with us the university or college associated with the chapter of Theta Delta Chi connected to this concern or incident. *

Time and Date

Please share what you know about the time and date that the concern or incident took place *

Persons Involved

Who were the person or persons involved *

Member(s) of Theta Delta Chi

At a location owned or run by Theta Delta Chi (Ie. a Chapter House or Central Chapter Location)

Friends or associates of members of Theta Delta Chi

Other:

Required

Please share as much as you can about the people involved with the incident or concern you are reporting *

Thank you for making us aware. Please share any other details that you feel we should be aware of.

Can we contact you directly with follow-up questions? *

Yes

Other:

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