SSU Misconduct and Grievance Referrals

All information highlighted in Yellow are instructions.

Reporting an Incident – SSU Misconduct and Grievance Referral

BEFORE COMPLETING THIS FORM: If this is an emergency that involves an imminent risk of harm to self or others, please contact local police at 911 prior to filling out this form.

The purpose of the Misconduct and Grievance Referral Form is to provide Southern States University community members, including students, staff, faculty, vendor, visitors, and others with a tool to refer concerning behavior to the University, file a grievance with the University, or request assistance from the University. Submitted forms will be reviewed no later than the next business day by the Director of Administration, who will forward the referral to the appropriate University official.

Depending on the referral type, SSU may use the information provided to begin an informal or formal inquiry and/or investigation, which may include contacting all involved parties and/or any potential witnesses in order to better understand the nature of the referral. However, if this form does not contain specific information, SSU’s investigation into the allegations and/or grievance may be limited.

This form may be submitted anonymously.

You are not required to complete the entire form in order to submit the referral. Please fill out as much information as you can.

For a review of SSU policies and procedures, please reference the following:


SSU Community Members may elect to complete the applicable form online or by printing the complete form and either emailing, hand-delivering, or mailing the completed form (instructions included). (

Emergency Incident or Behavioral Misconduct Form: (

Use the Emergency Incident or Behavioral Misconduct Form to report:

  • Emergency Incident: FIRST CALL 911 – This form is only to report the incident to University Officials AFTER emergency response personnel have arrived on scene and you are wishing to inform University administrators about the event.
  • Behavioral Misconduct, including possible unlawful behavior: Abuse of the Conduct Process, Alcohol, Animals, Bullying or Cyberbullying, Bystanding, Collusion, Damage/Destruction/Vandalism, Disorderly Assembly, Disruptive Behavior, Drugs, Endangering Self or Others, Failure to Comply, Falsification, Financial responsibilities, Fire Safety, Gambling, Hazing, Health and Safety, IT and Acceptable Use, Retaliation, Robbery, Sexual Harassment, Sexual Misconduct, Stalking, Taking of Property, Threatening Behaviors, Tobacco, Trademark, Trust, Unauthorized Access, Unauthorized Entry, Unwelcome Harassment, Water Safety (incl. flooding), Weapons, Wheeled or Flying Devices.
  • Discrimination, Harassment, or Bias: Use this form to report incidents based on race, color, national or ethnic origin, religion, sex, gender identity, gender expression, pregnancy (including pregnancy, childbirth, and medical conditions related to pregnancy or childbirth), physical or mental disability, medical condition (cancer related or genetic characteristics), ancestry, marital status, age, sexual orientation, citizenship, or service in the uniformed services (including membership, application for membership, performance of service, application for service, or obligation for service in the uniformed services)
  • Sexual Misconduct: Use this form to report sexual harassment, dating or domestic violence, sexual contact or touching, stalking, quid pro quo sexual requests, sexual assault, or sex-based bias or discrimination.

Student Welfare Form: (

Use the student welfare form if you are worried about a student who may be dealing with physical, mental, or emotional concerns. Such concerns may include but are not limited to mental health concerns (including anxiety, depression, etc.), suicidal thoughts or actions, making threats (either explicit or veiled), of demonstrating strange or unusual behavior.

University Administration Form (

This form is to be used to report Academic Misconduct, file a formal grievance against a University employee or policy, request an exemption to a University policy, request a disability accommodation, escalate an academic or administrative issue, or report a facilities concern.

  • Academic Misconduct: For reporting any actions or attempted actions that may result in creating an unfair academic advantage for oneself or an unfair academic advantage or disadvantage for any other member or members of the academic community. This includes a wide variety of behaviors such as academic dishonesty (plagiarism, cheating, collusion, reusing assignments, using prohibited sources, purchased assignments, use of surrogate(s)), altering academic documents or transcripts, gaining access to materials before they are intended to be available, and helping a student to gain an unfair academic advantage.
  • Request an Exemption to University Policy
  • Request Disability Accommodations – Accessibility: For requesting reasonable accommodations
  • Grievance: For instances of a real or imagined wrong or other cause for complaint or protest, especially unfair treatment
  • Escalation of an issue: For instances when departmental processes have failed to resolve an SSU community members problems or when there is not a well-defined procedure to address a unique concern
  • Facilities: For issues that require the attention of University personnel to fix a physical defect on campus, such as a broken sink, burnt-out lights, toilet leaks, doors that will not close, etc.