Title IX / Sexual Misconduct Report Form

Reporter Information

CUC will use the information provided to begin an investigation, which may include contacting the reporting party, responding party, and/or witnesses. The information you report will be treated confidentially. You may file a report anonymously or as a bystander or witness. You are not required to complete the whole form in order to submit the report. There are limitations to the university's ability to respond to reports submitted anonymously or with incomplete information.

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Reporter's full name:

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(or Anonymous)

Reporter's role at CUC:

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(e.g. student, employee)

Reporter's phone number:

Reporter's email address:

Email address must be of a valid format.

Nature of this report(Required):

This field is required.

Urgency of this report(Required):

This field is required.

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If Urgent, please call 9-1-1 or the CUC Dept. of Public Safety at (708) 209-3039

Date of incident(s)(Required):

This field is required.

* Time of incident(s):

Location of incident(s).(Required):

This field is required.

Specific location(s):

Parties involved in the incident

(e.g. responding party/survivor, respondent/alleged, witness or bystander, hearsay)

Name

Select Gender

Select Role

H number (if applicable and known)

DOB (YYYY-MM-DD)

Phone number

Email address

Hall/Address

Questions about incident(s)

Please provide a detailed description of the incident/concern using specific concise, objective language (Who, what, where, when, why, and how). Try to be as detailed as possible. If more than one incident/concern, please list.(Required) This field is required.

Describe the impact that the behavior has had on you: This field is required.

Have you reported this incident/concern to anyone else? If so, to whom?(Required) This field is required.

If you are the reporting party/victim/survivor, how would you like to proceed at this time? (check all that apply)(Required)

Get medical help or counseling Report to police Pursue University investigation Seeking information only Unsure

You must make at least one selection.

What remedy are you seeking? This field is required.

Supporting Documentation

At this time, please preserve any evidence (e.g. clothing, communication). Please provide photos, video, email and other supporting documents below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Reporter Information

Parties involved in the incident

Questions about incident(s)

Supporting Documentation

Submission