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Title IX/ Sexual or Gender-based Misconduct Reporting Form

If this is an emergency, please call 9-1-1.

Indian Hills Community College is responsible for upholding the Sexual and Gender-based Misconduct Policy, as well as our Title IX Policy. Those policies identify expectations for all students, faculty, and staff both on- and off-campus. If you have knowledge of an Indian Hills Community College student potentially violating either the Sexual and Gender-based Misconduct Policy or Title IX policy, you are encouraged to notify the Title IX Coordinator, at 641-683-5155 or 641-680-3171.

Click Here for the Sexual and Gender-based Misconduct Policy
Click Here for the Title IX Policy

Note: This reporting form is to be used for Title IX and/or Sexual and Gender-based Misconduct. Select from the following forms:

Click here for the Student Academic Integrity Form.

Click here for the General Complaint Form.

Click here for the Student Conduct/Concerning Behavior Form.

Click here for the Grievance Procedure for Discrimination Form

Non-Discrimination Policy: It is the policy of Indian Hills Community College not to discriminate on the basis of race, creed, color, sexual orientation, gender identity, national origin, sex, disability, religion, age, political party affiliation, or actual or potential parental, family or marital status in its programs, activities, or employment practices as required by the Iowa Code sections 216.9 and 256.10(2), Titles VI and VII of the Civil Rights Act of 1964 (42 U.S.C. § 2000d and 2000e), the Equal Pay Act of 1973 (29 U.S.C. § 206, et seq.), Title IX (Educational Amendments, 20 U.S.C.§§ 1681 – 1688), Section 504 (Rehabilitation Act of 1973, 29 U.S.C. § 794), and the Americans with Disabilities Act (42 U.S.C. § 12101, et seq.).

If you have questions or complaints related to compliance with this policy, please contact Associate Dean, Student Development, 525 Grandview Ave, Ottumwa, IA 52501, (641) 683-5155, equity@indianhills.edu (students, faculty and staff); Executive Dean, Centerville Campus and Learning Services, 683-5174, learningservicesequity@indianhills.edu (students with disabilities); Director of the Office for Civil Rights U.S. Department of Education, John C. Kluczynski Federal Building, 230 S. Dearborn Street, 37th Floor, Chicago, IL 60604-7204, phone number (312) 730-1560, fax (312) 730- 1576, ocr.chicago@ed.gov

Background Information

Your full name:

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Your position/title:

Your phone number:

Your email address:

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Nature of Report(Required):

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Urgency of this report(Required):

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Date of incident(Required):

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Time of incident:

Location of incident(Required):

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Specific location:

Involved Parties

Please list the individuals involved (excluding yourself), including as many of the listed fields as you can provide. For non-students, please list an SSN or Drivers License number in the block labeled SID (Student ID #) if available.

Name or Organization

Select Gender

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ID Number

Phone number

Email address

Hall/Address

Questions

Supporting Documentation

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