Report Form for Sexual Misconduct

Background Information

By providing your contact information: The Title IX Coordinator may contact you if more information is needed.

By reporting anonymously: The College will not attempt to identify and contact you.

Only fields with a red asterisk are required. If you do not know the date of the incident, please indicate the date that you are making the report.

Your first and last name:

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Legal or chosen name, if different.

Your phone number:

Your email address:

Email address must be of a valid format.

Your physical address:

Your Role(Required):

This field is required.

Date of incident(Required):

This field is required.

Time of incident:

Location of incident(Required):

This field is required.

Specific location:

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i.e. room number, specific floor or wing

Involved Parties

Please list the individuals involved, including as many of the listed fields as you know and are comfortable sharing. It will be helpful to include witnesses or individuals with knowledge of the incident. The College may conduct an investigation involving any named individuals and may share the details of this report with those individuals as necessary. If you have provided your name, the College will try to maintain your anonymity throughout the course of the investigation but cannot promise this outcome.

Name (legal or chosen, if different)

Select Status

Select Role

Phone number

Email address

Hall/Address

Description/Narrative of Incident

Please provide a detailed description of the incident/concern using specific, concise, objective language.(Required) This field is required.

What did you observe or what was reported to you?(Required) This field is required.

If the incident was reported to you, what is the name of the person who told you about it, and what is their relationship with you and the person you are concerned about?(Required) This field is required.

To your knowledge, has anyone else been notified of this situation? If yes, please list those individuals in the box below: This field is required.

If you have provided your identity in this report, do you wish to remain anonymous?(Required)

No Yes *Note: If it is your preference to remain anonymous, the College will make every effort to maintain anonymity but it cannot be promised.

This field is required.

You have the right to make a report to Law Enforcement. Would you like assistance with making a report?

Yes No

This field is required.

Resolution Requested:(Required)

Option One: Formal complaint and investigation under the Sexual Misconduct Policy (An investigation will result in a finding as to whether the policy was violated, and if so, appropriate sanctions will be issued.) Option Two: Informal Resolution (This option is designed to provide flexibility in addressing incidents of sexual misconduct in order to meet the expressed wishes of the parties. For example, a Complainant can request a No Contact Order, training and education for the Respondent, writing an impact statement, or other tailored remedies) Option Three: I do not want the College to take action at this time. Option Four: I want to learn more about my options before I make a decision. Please contact me. Other

This field is required.

If "Other" was selected above, please describe. This field is required.

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Email me a copy of this report

Background Information

Involved Parties

Description/Narrative of Incident

Supporting Documentation

Submission