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Sexual Harassment or Other Forms of Discrimination or Harassment


If this report constitutes an emergency situation, please contact Public Safety at 610-330-4444 instead of completing this form. This form is not to be used for an urgent or emergency situation.

This form should be used to report incidents or concerns of sexual assault, sexual or gender based harassment, domestic violence, dating violence, or stalking. This form should also be used to report other forms of discriminatory harassment on the basis of actual or perceived membership in a class protected by policy or law. This report goes directly to the Director of Educational Equity / Title IX Coordinator, and the Dean of Students / Deputy Title IX Coordinator, who will respond promptly, typically within 1-2 business days.


All mandated reporters are required to include their own name and contact information, but not that of the Complainant. Others may submit this form anonymously; however, the College's ability to respond may be limited.

Please note that completion of this form does not constitute a formal complaint of sexual harassment. Upon receipt of a One Pard form regarding sexual harassment, the Title IX Coordinator will contact the reporting student and/or student who experienced the misconduct (Complainant), if identified, to offer resources and offer to discuss options.

Your Information

Fields with a red asterisk are required. If you do not know the date of the incident, please indicate the date that you are making the report (today).

 
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Please include your first and last name
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Please include all numbers where you can be reached
Email address must be of a valid format.
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Date of incident, if known. If not, enter today's date
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Examples include room numbers, floors, outdoor locations, etc.

Involved Parties

Please provide as much identifying information for all individuals and/or organizations involved in the situation as you are aware of, including any witnesses to the event or individuals with knowledge about the event. You are also able to provide this information when meeting with the Title IX Coordinator.

Involved party 1

Questions

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What is your Lafayette Affiliation?(Required)
You must make at least one selection.
How would you prefer to be contacted should we need additional information?(Required)
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Supporting Documentation

This could include screenshots of texts, videos, photos, e-mails, or other supporting documents. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission