Formal Complaint of
Racial Discrimination


This Report provides community members with the opportunity to notify the College of prohibited conduct. This form is used to formally file a complaint of racial discrimination.

Florida Southern College (the “College”) is committed to the principles of equal opportunity and seeks to establish and maintain an environment which ensures equal access to education for all College community members including students, applicants for admission, employees, applicants for employment, guests, and visitors. To foster this environment, the College encourages individuals with knowledge or concerns of an incident of discrimination to report the incident to either of the College’s Title IX Co-Coordinators.

In this document, you will see various terms. The definitions of these terms are below:

  • Complainant: An individual who is alleged to be the victim of conduct that could constitute sexual harassment
  • Respondent: An individual who has been reported to be the perpetrator of conduct that could constitute sexual harassment
  • Witness: An individual with first-hand knowledge of the alleged incident. This may include someone you told about the alleged incident after it occurred.

Anonymous Reports

The College accepts anonymous reports, which will be reviewed by the Title IX Co-Coordinator(s) and included in campus safety assessments. If an anonymous report is submitted by a third-party and contains the identity of the complainant, the Title IX Co-Coordinator will contact the complainant to inquire about the incident, offer supportive measures, and explain the process for filing a formal complaint. If an anonymous report does not contain the identity of the complainant, the College will be unable to contact the complainant and offer supportive measures. While the Title IX Co-Coordinator will keep confidential the identity of the complainant (unless disclosing the complainant’s identity is necessary to provide supportive measures such as no-contact orders), the Title IX Co-Coordinator must know the identity of the complainant to offer supportive measures.

Any person (the actual complainant or a third party) may report anonymously using the appropriate anonymous reporting form. However, the College’s ability to respond to anonymous reports is significantly limited.

Reporting Forms

Complaints of Sexual Discrimination

In accordance with the Florida Southern College Policy on Sexual Misconduct & Sexual Harassment, any person may report an incident(s) of sex discrimination, sexual misconduct, or sexual harassment to the Title IX Co-Coordinator(s). Forms of sexual harassment include sexual assault, dating violence, domestic violence, and stalking. The reporting party may be the person directly affected by the alleged incident (referred to as “complainant”) or a third party.

Regarding complaints of sexual harassment, it is important to note the following:

  1. Title IX is a federal law that prohibits discrimination on the basis of sex in education programs or activities receiving federal financial assistance. Sexual harassment is a form of sex discrimination, and Title IX defines sexual harassment as conduct on the basis of sex that constitutes one or more of the following three types of behavior:
    1. Quid Pro Quo harassment - When a person's participation in an education program or activity is directly tied to submitting to unwelcome sexual advances, requests for sexual favors, or other verbal, nonverbal, or physical conduct of a sexual nature.
    2. Severe, Pervasive, and Objectively Offensive Conduct that Denies a Party Equal Educational Access
    3. Sexual Assault, Dating Violence, Domestic Violence, and Stalking
  2. Under Title IX, Florida Southern College (the “College”) is obligated to investigate formal complaints of sexual harassment and will treat parties equally and equitably throughout the grievance process. For more information about the definitions of sexual harassment, filing a formal complaint, and the Title IX investigation and grievance process, refer to the Florida Southern College Policy on Sexual Misconduct & Sexual Harassment.
  3. Important: Only the individual who is the alleged victim of conduct that could constitute sexual harassment ("complainant") may file a formal complaint.
  4. Filing a formal complaint will initiate the Title IX grievance process, which requires notifying the respondent of the allegations and grievance process.
  5. If a Title IX Co-Coordinator receives a formal complaint which does not meet the Title IX definition of sexual harassment, they will contact the complainant to discuss available options.

See the Sexual Misconduct & Sexual Harassment Policy for more information about the College’s complaint resolution procedures as well as the Title IX formal complaint and grievance process.


If you have questions about filing a formal complaint, we encourage you to contact one of the Title IX Co-Coordinators. The Title IX Co-Coordinators’ contact information is as follows:

Amanda Blount, Ed.D.

Title IX Co-Coordinator, Assistant Dean of Student Development for Accountability, Education, and Compliance
Carlisle Rogers Building, 244

Katherine Pawlak

Title IX Co-Coordinator, Assistant Vice President for Operations & Director of Human Resources
Raulerson Building

Once the report is received, the Title IX Co-Coordinator will contact the complainant to discuss supportive measures and explain how to file a formal complaint and/or initiate the complaint resolution procedures, if applicable and desired by the complainant. Supportive measures will be available to complainants regardless of whether or not they wish to file a formal complaint to initiate a Title IX grievance process or complaint to initiate the College’s grievance procedures.

Complainants, respondents, and reporters may also contact Counseling Services, if desired, which can be found on pages 30 & 31 of the Sexual Misconduct & Sexual Harassment Policy.

Thank you for filing a formal complaint. You can find additional resources about the College’s policies and protocols regarding incidents of discrimination, including sexual harassment on our website.

Additional Resources

Complainant Information

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Basis of the Complaint

*Basis of Complaint (check all that apply):

Respondent Information

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Description of Complaint

Please describe in detail the incident(s) you consider to be discriminatory or retaliatory and why you believe this person discriminated or retaliated against you. Also, please provide the date(s) and locations(s) for each incident including first and last names of individuals involved. Explain why you have contact with these individuals (supervisor, co-worker, faculty, customer, etc.).

Do you have any documentation supporting your complaint such as text messages, print screens, or e-mails? If so, please provide copies of the documentation supporting your complaint along with any explanation behind the documentation.

Have you brought this matter to the attention of any other person or department at the college or any external agency such as law enforcement or the EEOC? If so, please list the name(s) and department(s) of all other persons with whom you have discussed this matter and when you had the discussion.
Describe the relief or corrective action you are seeking from the college and/or the respondent.


Identify the witnesses who will support your allegations.

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Authorization and Signature

I understand that by submitting this formal complaint, I am knowingly initiating the formal grievance process (i.e. formal investigation) related to the allegations that have been described.

I understand that upon receipt of this formal complaint, the Title IX Co-Coordinator may contact me to gather additional information, if necessary.

I understand that upon the Title IX Co-Coordinator’s review, the College will dismiss a formal complaint of sexual harassment under Title IX if the alleged conduct:

  1. Would not constitute sexual harassment as defined in the Sexual Misconduct & Sexual Harassment Policy if proven;
  2. Did not occur in the College’s education program or activity; or
  3. Did not occur in the United States.

I also understand that if a formal complaint of sexual harassment under Title IX is dismissed, the Title IX Co-Coordinator will notify the respondent and me of the dismissal. However, the behavior that does not meet the above criteria may still be addressed under different College policies.

By typing my name below, I confirm that I am the person making this formal complaint. I also confirm that the information provided in this formal complaint is true to the best of my knowledge.