Amorous Relationship Disclosure Form

University of Connecticut Amorous Relationship Disclosure Form

“Amorous Relationships” are defined as intimate, sexual and/or any other type of amorous encounter or relationship, whether casual or serious, short-term or long term. A faculty member, staff member, or graduate student who is or becomes involved in an amorous relationship with another employee or a student in violation of the Policy Against Discrimination, Harassment and Related Interpersonal Violence must disclose the relationship immediately to the Office for Inclusion and Civil Rights (OICR). Labor Relations and the applicable manager/academic leader will determine whether the conflict of interest can be eliminated through termination of the situation of authority. The final determination will be at the sole discretion of the manager/academic leader. This form is intended to assist employees/graduate students in fulfilling their disclosure requirements under the Policy Against Discrimination, Harassment and Related Interpersonal Violence. Following the completion of this form, you will be contacted regarding next steps.

This field is for validation purposes and should be left unchanged.

Your first name:(Required)

Your last name:(Required)

Your title:(Required)

Your department:(Required)

Your email address:(Required)

Your manager or academic department head's name:(Required)

Your manager or academic department head's email address:(Required)

Name of the employee or student with whom you have a relationship with. For students, please indicate student standing (i.e., undergraduate, graduate, law student, etc.):(Required)

Email address of the employee or student with whom you have a relationship with:(Required)

Please describe the nature of the relationship:(Required)

Describe any supervision or authority you have over the individual identified above:(Required)

University of Connecticut Amorous Relationship Disclosure Form

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