Title IX Reporting Form

Step 1 of 3

Is the complainant a student or employee?
Complainant: a person who has reportedly experienced sex discrimination, sexual harassment, sexual assault, domestic violence, dating violence, stalking, or other Title IX related incident.

StudentEmployee

Reporter’s Name

First

Last

Reporter’s Email

Reporter’s Phone

Are the Reporter and the Complainant the same person?
Complainant: a person who has reportedly experienced sex discrimination, sexual harassment, sexual assault, domestic violence, dating violence, stalking, or other Title IX related incident.

YesNo

Step 2 of 3

Date of Incident
Please provide the date of the reported incident if known (not the date of this report)

Time of Incident

Please provide the time of the reported incident if known (not the time of this report)

Incident Description

Please take your time and provide as much detail as possible regarding the reported incident including the names of involved individuals and specifics of the alleged behavior.

Location of Incident

Please provide anything known about the reported location of the incident including if this was off or on campus.

Step 3 of 3

Respondent

Respondent: Generally, the Respondent is the person alleged to be responsible for the prohibited conduct in a complaint.

Respondent Email (if known)

Additional Complainants

If there are additional Complainants, please provide their information in this box.

Witnesses

Please list any individuals who may have knowledge relating to the incident.

Attach Documents/Upload

If you have additional documents including police reports, text messages, pictures, or other potential evidence, please upload those documents here.

Certification

I certify the information provided in this report is true and correct.

Title IX Form

Title IX Reporting Form

Step 1 of 3

Step 2 of 3

Step 3 of 3