Title IX Complaint Form

Definitions & Background Information

Find definitions of common terms on our Title IX webpage in the "Learn More About Title IX" section.

Common Terms:

Quid Pro Quo Harassment

Hostile Environment

Sexual Assault

Domestic Violence

Dating Violence

Stalking

Please note, for the Location field below: Includes locations, events, or circumstances over which the College exercised substantial control over both the respondent and the context in which the sexual harassment occurs, and also includes any building owned or controlled by a student organization that is officially recognized by the College.

Your full name:

Your phone number:

Your email address:

Email address must be of a valid format.

Your physical address:

Nature of this report(Required):

This field is required.

Learn more

Who is the complainant and who is the complaint against?

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

ID Number

Phone number

Email address

Address

Questions

Are you a LWTech student, employee or other?(Required) This field is required.

Is the complaint against a LWTech student, LWTech employee and/or other?(Required)

Student Employee Other (such as community member or vendor)

You must make at least one selection.

Please describe your complaint with as much detail as possible. Please include who, what, when, where, and how the incident(s) occurred.(Required) This field is required.

Please describe the ideal resolution to your complaint.(Required) This field is required.

Did this incident occur during a LWTech education program or activity?(Required) This field is required.

Did this incident occur in the United States?(Required)

Yes No

This field is required.

Is this a grade appeal?(Required) This field is required.

Is your concern about accommodations?(Required)

Yes No

This field is required.

Is your concern about faculty performance?(Required) This field is required.

Supporting Documentation

Please attach any documents that will help us to understand your complaint. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Email me a copy of this report

Definitions & Background Information

Involved Parties

Questions

Supporting Documentation

Submission