OPLE Professionalism Concern Submission Form

OPLE Professionalism Concern Submission Form

Date Event Occurred*

Campus*

Please select the campus where the event occurred. You may select more than one site

Select

Other Campus Location

Please enter "Other" Campus location information here

Program/Unit

Please provide the department and/or unit information where the event occurred.

Allegation*

Please describe the event.

Name of Complainant

Name of the person who is reporting/filing the complaint or issue.

Please note this information will be kept confidential. If you speak with OPLE, you have the option to be anonymous after.

Role of Complainant

Select

Additional Complainant Role

Please enter "Other" complainant role information here

Gender Identity of Complainant

Select

Name of Respondent

Name of the person who the complaint is being reported/filed against.

Please note this information will be kept confidential.

Role of Respondent

Select

Additional Respondent Role

Please enter "Other" respondent role information here

Gender Identity of Respondent

Select

Respondent Employer

Please Select the Respondents Primary Employer

Select

Follow-up Information

Conversations with OPLE are confidential. If you speak with OPLE, you have the option to be anonymous after.

However, confidentiality cannot be guaranteed if there is an imminent risk of serious harm, or if there is an allegation of sexual or race-based misconduct or any other misconduct based on legally protected characteristics.

Name of Individual submitting report

Best email for follow-up

Best way to reach you

Please provide best way for OPLE to reach out to you.

Additionally, the OPLE team can be reached in several ways:

1. Dedicated confidential hotline: 646-317-7275

2. Dedicated confidential email: ople@nyp.org

Send me a copy of my responses

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