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Title IX (Sex Discrimination/Harassment & Sexual Violence) Reporting Form


This Incident Report is for incidents involving allegations of discrimination or misconduct based on sex/gender or Retaliation related to sex/gender. This includes incidents falling under Title IX of the Education Amendments of 1972 - Sexual Assault, Sexual Misconduct, Sexual Harassment, Interpersonal Relationship Violence (Dating or Domestic Violence), and Stalking. Please fill out as much information as possible based on your knowledge of the situation.

If you wish to remain anonymous, please leave the following fields blank - Reporter Name, Reporter Title, Reporter Phone, and Reporter E-Mail. Responsible Employees must complete all Reporter Fields. If you leave these fields blank, you will not receive any confirmation of your report being filed.

Filing this incident report constitutes official notice to The University of Toledo and may result in the institution commencing an investigation into the information and allegations contained within the report.

This report is not confidential.

Submitting this report notifies the Office of Title IX and Compliance:
*Vicky Kulicke, Director, Title IX and Compliance & Title IX Coordinator
*Michelle McDevitt, Assistant Director, Title IX and Compliance & Deputy Title IX Coordinator 

If you wish to explore confidential reporting options, please contact the following resources:
*Main Campus Medical Center - 419.530.3451
*University Counseling Center - University Health Center, Main Campus, 419.530.2426
*YWCA Rape Crisis Center 24 Hour Hotline - 866.557.7273 or 419.530.3431

If you wish to explore non-confidential reporting options, please contact the following resources:
*Title IX Office - 1120 Snyder Memorial, 419.530.4191
*Office of Student Conduct and Community Standards - 2514 Lancelot Thompson Student Union, 419.530.1258
*University of Toledo Police Department - Public Safety Building- 419.530.2600 (non-emergency) 9-1-1 (emergency)

Filing this report DOES NOT constitute filing an official Police Report with the UToledo Police Department and/or any Local Police Department. To file a Police Report, please contact the University of Toledo Police Department at 419-530-2600 or in person at the Public Safety Building on the main campus (for incidents occurring on UT Campus Property) or contact the law enforcement agency for the municipality in which the incident occurred (for incidents occurring off campus).

The following terms are used below:
*Reporter: The person who submits the report. The reporter may be the complainant or a witness who knows about an incident/situation.
*Complainant: The person who experienced the alleged violation or harm.
*Respondent: The person accused of perpetrating the alleged violation or harm.
*Witness: A person who saw or heard an incident occur or who has relevant information about it.
*Mandatory Reporter: All University employees (with limited exceptions) including faculty, administrators, staff and residence advisors, must report any incidents of possible sexual harassment, sex discrimination, or sexual violence in which they are aware.

Reporters Information

 
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Student, Staff, Faculty, Other
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Persons Involved

Please list all individuals involved, including the victim (complainant). Include as many of the listed fields as you can provide. For Non-UT Persons, please list any known information (SSN or Drivers License Number) in the block labeled "R Number" (if available).

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Questions

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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.

Submission