MILES Committee
Mistreatment Incident and Learning Environment Surveillance

Form to Report Student Mistreatment


If you or another person is in imminent physical or psychological danger, please call 911 or contact the Campus Police (410-516-7777) or Security Office (410-516-4600), Dean Koenig in the Office of Student Affairs, contact UHS/Mental Health, report to the Emergency Department, or contact the police.

Instructions
Fill out the form below to report mistreatment. All fields marked with a * are required.
Select the submit button when finished.

Submitter Information
     
Anonymous claims will be confidentially investigated, maintaining complainant anonymity to the extent possible, however, based on facts of a case, anonymity cannot be guaranteed. Anonymous complaints will be logged and investigated to the extent possible, however, without the ability to obtain additional information from the complainant/reporter, be advised that it is difficult to process such investigations.
This field is required
This field is required
This field is required
The Emails are not match
If you provide a non-Hopkins email, there are limits to ensuring the security of your email.
This field is required       
Mistreatment Information
This field is required

Time Period Event Occurred
This field is required
This field is required
This field is required
This field is required
Source of Negative Behavior
If you do not remember the person's name, put "not sure" in the first and last name fields.
This field is required
This field is required
This field is required
Please list any other information about the Source of Negative Behavior. For example, if you cannot remember exactly who it was, please describe the person and their position. If it was multiple people or an entire team involved in the mistreatment, please list them here.
Description of Mistreatment
This field is required
Please describe the incident(s) in as much detail as you possibly can and you are comfortable sharing.
If you would rather schedule a meeting to discuss the details in person, please indicate that here.
This field is required
Please choose all that feel relevant to the incident in question. Do not worry about “official definitions” of these terms; these we will be used by the Office to help organize reports and detect broader trends or issues in the learning environment.

Please select Yes if you believe this is an urgent matter to be handled immediately.
What level of follow-up would you like? * This field is required
There are circumstances under which follow-up might be required.


As a reminder, here is a link to the committee membership.

As a reminder, here is a link to the committee membership. We cannot guarantee that a particular faculty member might be available.



Demographics
This section is used for data-gathering and detection of troubling patterns. It is ENTIRELY OPTIONAL.

What is your current gender identity? Please select all that apply.

What sex were you assigned at birth, on your original birth certificate?
Select all that apply

Do you consider yourself to be: - Selected Choice



 


Input symbols