Title IX Reporting Form

Reporter's Information

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Your full name:

Your Role:

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Current Student; Current Staff Member; Current Faculty Member; Former Student; Former Staff Member;

Your Phone Number:

Your Email Address:

Email address must be of a valid format.

Urgency(Required):

This field is required.

Incident Date(Required):

This field is required.

Incident Time:

Incident Location(Required):

This field is required.

Specific Location:

Involved Parties

Please include information about the Complainant, Respondent, and any known Witnesses or third parties, including as many of the listed fields as you can provide.

For clarity the following definitions are provided:

Complainant: Any individual who is alleged to be the victim of conduct that could constitute sexual harassment. At the time of the filing of a formal complaint, a complainant must be participating in or attempting to participate in the education program or activity of the recipient with which the formal complaint is filed. Any person may report sex discrimination, including harassment, whether or not the person reporting is the person alleged to be the victim of discrimination or harassment.

Respondent: An individual who has been reported to be the perpetrator of conduct that could constitute sexual harassment.

Name

Role

UAM ID Number

Phone Number

Email Address

Residence Hall or Address

Nature, Description, & Additional Information

What is the nature of this report?(Required)

An employee of the University conditioning the provision of an aid, benefit, or service of the institution on an individual’s participation in unwelcome sexual conduct Unwelcome conduct determined by a reasonable person to be so severe, pervasive and objectively offensive that it effectively denies a person equal access to the University’s educational programs or activities Sexual assault Dating violence Domestic violence Stalking Retaliation Unsure/unknown

You must make at least one selection.

Please provide a narrative description of the incident. Be sure to provide as much information as possible about the incident using specific concise, objective language (who, what, where, when, why, and how).(Required) This field is required.

Has this been reported to law enforcement?(Required) This field is required.

Please enter your full name as an electronic signature to submit this form.(Required) 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

Reporter's Information

Involved Parties

Nature, Description, & Additional Information

Supporting Documentation

Submission