This form is to be used to submit a grievance in which you have been unable to satisfactorily resolve with the faculty, staff, students, or others involved. Please complete all fields so your grievance can be reviewed.

For Civil Rights grievances (including race- and gender-based discrimination), contact:
Lindsey Garza

Please indicate your relationship to the RELLIS Campus.

Please select the report type which represents the issue you are submitting.


Please provide the approximate date or time frame that this incident occurred. If this is not known, indicate when you were first made aware of the concern. *Ex: MM/DD/YYYY or Term YYYY

If applicable, indicate the time the incident occurred. Ex: HH:MM PM

Please provide as much information as possible (there is a 32,000 character limit).

Please list the names (and ID numbers if possible) of all persons and/or groups that were involved in this incident.

Select all institutions in which you are affiliated.