Concern and Complaint Form
Mercy College of Ohio values the quality of education provided to students. At times, concerns arise that may need to be addressed. The Concern/Complaint process was designed as a way to notify the appropriate individual(s) so that the College can appropriately address the concern/complaint. Students, faculty, and staff are encouraged to use this form.
This form is an official communication with the College and initiates an investigation of the concern or complaint. Representatives of the Campus Assessment Response and Evaluation (CARE) Team will evaluate the report during normal business hours and determine the type of follow-up necessary to address the concerns.
Call 911 immediately to report life threatening situations, immediate danger, or extreme threats.
If you observe behavior that may result in harmful or threatening conduct, please contact Mercy Health Public Safety immediately by calling 419-251-4444 for the Toledo campus and 330-480-3288 for the Youngstown location.
When selecting the nature of the report below, please use the following definitions for types of concerns and complaints:
• Discrimination/Bias Report – for concerns or actions impacting you or the Mercy College community that are enacted because of bias based on actual or perceived race, color, national and ethnic origin, sex, sexual orientation, disability, age, marital status, religion, pregnancy, genetic information, and any other legally-protected class. This also includes sex, sexual orientation and gender identity/expression when the behavior is not sexual assault or sexual harassment.
• Conduct Report – for alleged misconduct and violations of the Student Code of Conduct that occur on or off-campus involving Mercy College students and/or student organizations. The Student Code of Conduct is available in the
• Individual Complaint or Concern – for general issues related to your Mercy College experience that you would like to bring to the attention of the College administration that are not alleged violations of policy or bias-related issues. The Student Complaint Policy is available online:
Student Complaint Policy (PDF)
• Student Issue and/or Concern – for concerns you would like to report about a Mercy College student who you feel may be struggling physically or with his/her mental health. These general issues are not alleged violations of policy or discrimination/bias-related.
• Sexual Assault/Sexual Harassment (Title IX) – for concerns or actions that are experienced or observed that involve sexual assault or sexual harassment based on sex/gender discrimination. This includes sexual assault or sexual harassment based on sexual orientation or gender identity/expression. The Title IX, Violence Against Women and Campus SaVE Policy is available online:
Title IX, Violence Against Women and Campus SaVE Policy (PDF)
FOR FACULTY USE ONLY
Academic Concerns– for concerns regarding a student’s academic performance, please use the
Early Alert Referral
By checking this box, I acknowledge that
if there is an immediate threat related to this report
, I have already contacted 911 or Mercy Health Public Safety to report it and will continue filling out this form as a way to notify the College.
Note: Fields marked with an * are required.
Based on the nature of this report, check all issues of concern that may apply.
Student Conduct Report
Individual Complaint or Concern
Sexual Assault/Sexual Harrassment
Location of Incident:
Name of Reporting Party:
Provide your full name.
Relationship to Student or Affiliation to Mercy College
Administrative or Staff Member
Faculty or Instructor
Mercy Health Public Safety
Phone Number of Reporting Party:
Provide your phone number (with area code) so we can contact you if we have follow-up questions about this report.
Email of Reporting Party:
Provide your email address so we can contact you if we have follow-up questions about this report.
Provide first and last name of the student you are concerned about.
Description of Incident / Concerning Behavior Information:
Enter student's name in description-Provide a detailed description of the incident or concern. Use concise and objective terms to describe your interactions and the specific behaviors you observed.
Date of Concern:
Use approximate date if actual date is not known.
Time of Incident:
Use approximate time if the actual time the situation occurred is not known.
Provide as much contact information you have for reaching this student.
Student Birthdate (if known):
Student Address (if known):
Address Line 2
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Bosnia and Herzegovina
British Indian Ocean Territory
Central African Republic
Democratic Republic of the Congo
Republic of the Congo
Papua New Guinea
Saint Kitts and Nevis
Saint Vincent and the Grenadines
Sao Tome and Principe
Trinidad and Tobago
United Arab Emirates
United States Minor Outlying Islands
Virgin Islands, British
Virgin Islands, U.S.
Student Email Address (if known):
Student Phone Number (if known):
Witness Contact Information:
Provide name(s), address(es), phone number(s), email(s) of witness(es).
Attach a File
Attach documents/upload photos, video, email, and other supporting documents of incident may be attached.
Additional Supporting Document (if applicable)
Do Not Fill This Out