Actionable Complaint Form

This form has been designed to submit an Actionable Complaint of sexual violence or misconduct.

Submitting an anonymous report does not limit a survivor from choosing to submit an actionable complaint later.  For definitions including, anonymous report, disclosure and actionable complaints and third party reporting see policy A-5.18.  

NLC recognizes the confidentiality and privacy rights of everyone involved in a complaint or report of sexual misconduct involving a student and must protect personal information in accordance with the Freedom of Information and Protection of Privacy Act.  Note that confidentiality is not equal to anonymity.  Should a complainant proceed with an actionable complaint, the Respondent must be made aware of the nature of the complaint, including the identity of the complainant to ensure procedural fairness. 

If you did not intend to choose actionable report and wish to go to the anonymous report form please click “Take me to the Anonymous Report Form”.

Actionable Complaint Form

I wish to report an incident of: (select the one which best describes your report) *

• Sexual Assault
• Sexual Exploitation
• Sexual Harassment
• Stalking
• Stealthing
• Indecent Exposure
• Voyeurism
• Technology-Facilitated Sexual Violence including Non-consensual posting of sexually explicit pictures or videos.
• Other

Review the Sexual Violence and Misconduct policy here to view the definitions of each

If Other: *

The incident occured: *

• On Atlin campus
• on Chetwynd campus
• On Dawson Creek campus
• On Dawson Creek campus, Farm site
• On Dease Lake campus
• On Fort Nelson campus
• On Fort St. John campus
• On Tumbler Ridge campus
• In NLC student housing, Dawson Creek campus
• In NLC student housing, Fort St. John campus
• Off-campus, at a NLC related activity
• Off-campus, at a non-NLC related activity or place
• Online
• Other

If Other: *

Provide additional details about the location where the incident occurred (ie: where on campus, at what address off campus, etc). *

The incident happened: *

• I know the exact date
• On more than one date
• I do not know the exact date

Exact date of incident *

Dates of incident (multiple occurrences) *

Incident timeline *

• Less than a month ago
• More than a month ago
• More than a year ago

I am (select one from the following list) *

• a NLC student
• a NLC employee
• a member of the public

I believe the person who harmed me is a *

• a NLC student
• a NLC employee, faculty or support staff member
• Other

If Other: *

What is the perceived gender(s) of the persons who harmed you? *

• Man
• Woman
• Trans Man
• Trans Female
• Non-binary
• Unknown

Describe the individual(s) who harmed you (ie: hair color, eye color, height, weight, type of clothing worn, any thing else that may be an identifier) *

Additional Information

Please use this space to include any additional information you wish to share. Describe in as much details as possible, the incident(s).

Please include:
– the names of the parties involved
– names of witnesses to the incident
– the date and time of the incident(s) including the location (physical location or digital)
– include behaviours, words, descriptions about the place or situation and other details about the incident.
– and any other details you think may help with the investigation.

Attach any supporting documents, such as emails, handwritten notes, screenshots of online activities, or photographs here.

Drag & Drop Files, Choose Files to Upload You can upload up to 20 files.

Contact information of Complainant

Complainant Name *

Employee/Student ID number *

Phone *

Email *

and “I persons

Contact information of the Respondent(s) – the person(s) who harmed you

Respondent Name(s) *

Contact information (if known)

Relationship to the complainant (optional)

I confirm that I wish to submit an actionable complaint to Northern Lights College under the Sexual Violence and Misconduct Policy and I understand that the information provided will be used by Northern Lights College to determine whether an investigation will be initiated under the Sexual Violence and Misconduct Policy or any other College policy, as applicable. I understand that by selecting “I agree and understand” that I am consenting to the submission of the information contained in this form. *

• I agree and understand

Submit as an Actionable Complaint (be sure you have read the information below this button before proceeding to submit your complaint).

You will not receive a copy of your actionable complaint when you click submit. If you wish to keep a copy it is suggested you take a screenshot or paste your responses into a Word document. The College will review your submission and someone will contact you within 72 hours.   If you believe you or others are at risk of immediate harm please call 911.  

NOTE: If at this time you have changed your mind and would like to continue with an anonymous report and you DO NOT want the College to proceed with an investigation you may click the button below called “Take me to the Anonymous Complaint Form”.  You will want to highlight and copy your written statements above and paste them into a Word document if you wish to use them in the anonymous complaint form.  Once you click the anonymous complaint form button you may not be able to come back to this screen to collect your entry.