Golden West College Student Sexual Harassment/Title IX Report

Background Information

Your full name:

Your phone number:

Your email address:

Email address must be of a valid format.

Urgency of this report(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:

Involved Parties

Name or Organization

Select Role

ID Number

Phone number

Email address

Questions

Describe the incident. What happened? When? Who was involved?(Required) This field is required.

What referrals/resources have you already provided to the student? Suggested Source: https://www.goldenwestcollege.edu/titleix/reporting-options/index.html(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

Background Information

Involved Parties

Questions

Supporting Documentation

Submission