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Sexual Harassment/Title IX Reporting Form

This form is designed to provide University students, employees, faculty, vendors, visitors, or others with a method to report specific information related to an alleged incident(s) of sexual harassment, including sexual assault, rape, forcible fondling, dating violence, domestic violence, stalking, or retaliation. This form is also to report or request accommodations for students who are pregnant or parenting. You are not required to complete the entire form in order for the complaint to be submitted.

Reports made through this online reporting system go directly to the Title IX Office, and access to the report is limited to the Title IX staff. The Title IX Office reviews and looks into all reports of sexual misconduct or harassment, including anonymous reports. Information provided in the online report will be used to determine how the University proceeds. Please be aware that the University's ability to fully respond to an anonymous report may be impacted.

*COMPLETING THIS COMPLAINT FORM DOES NOT CONSTITUTE A FORMAL COMPLAINT PER THE DEFINITIONS CONTAINED IN THE SEXUAL HARASSMENT/TITLE IX POLICY. DETAILS ABOUT THE FORMAL RESOLUTION PROCESS AND METHOD FOR SUBMITTING A FORMAL COMPLAINT WILL BE PROVIDED TO THE IMPACTED PARTY (IF KNOWN) UPON RECEIPT OF THIS REPORT.*

Upon receiving a report of an incident of sexual harassment, a member of the Title IX team will promptly contact the impacted party (if known) to:

Discuss the availability of supportive measures;
Consider the impacted party's wishes with respect to supportive measures;
Inform the impacted party of the availability of supportive measures with or without the filing of a formal complaint and, if applicable, the filing of a crime to local law enforcement;
Explain the process for filing a formal complaint;
Discuss protection from, and reporting of, incidents of retaliation.

IF YOU REQUIRE IMMEDIATE OR EMERGENCY ASSISTANCE, PLEASE CONTACT CAMPUS SAFETY AT 561-237-7226 OR CALL 911

CONFIDENTIAL REPORTING OPTIONS: Reports made to the following DO NOT trigger a University Investigation
Confidential offices are trained to respond to reports of sexual and gender-based misconduct and can assist the reporting party in obtaining support and interim measures as needed:

Confidential Student Supporters: https://tinyurl.com/lynnconfidential
Counseling Services: 561-237-7237
Student Health: 561-237-7231
Confidential Reports may also be made 24 hours a day/7 days a week by contacting Palm Beach County Victim Services at 866-891-7273

*If the person completing this form is the victim, you may choose to identify yourself or not. If you are a third-party complainant who is not the victim and is not a responsible employee, include the victim’s identifiable information only if the victim wishes.

**Victims completing this form who provide personally identifiable information can expect the university to follow up with an appropriate investigation. For information-only reports, victims should omit all personally identifiable information to ensure confidentiality.

If you are a Responsible Employee mandated to report incidents of sexual harassment, you may utilize this reporting form to fulfill your reporting obligations. This form should be completed and submitted as soon as possible after learning of an incident that may violate the Sexual Harassment (Title IX) Policy. Responsible Employees are required to provide their name and contact information when making a report of sexual harassment.

Background Information

Your full name:

Your email address:

Email address must be of a valid format.

Type of complaint(Required):

This field is required.

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:

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Additional location information

Involved Parties

Please list the individual(s) involved (excluding yourself). Include information about alleged perpetrator(s), witness(es) or any individual(s) you believe may have information that is relevant to the investigation. For each name, please write the person's role in the incident if known.

Person Name

Select Gender

Select Role

ID Number (if known)

Phone number

Email address

Dorm/Address

Questions

Victim’s affiliation to Lynn University This field is required.

Alleged Perpetrator’s affiliation to Lynn University This field is required.

Nature of Alleged Perpetrator’s Relationship to the Victim: This field is required.

Was this Incident Reported to Law Enforcement? This field is required.

While providing details is essential to investigating your complaint, please be advised that some or all of the information you provide in this section may be shared with the person(s) being accused. You may supplement this description later if you wish to share additional details. Describe the incident(s)/event(s) including dates, times, locations, and any potential witnesses to the behavior: This field is required.

By submitting this form, I certify that the information I have provided is true and accurate to the best of my knowledge and recognize that any individual who knowingly files a false report or formal complaint under this policy, who knowingly provides false information to University officials, or who intentionally misleads University officials who are involved in the investigation or resolution of a report of sexual harassment or retaliation may be subject to disciplinary action up to and including termination or dismissal.(Required)

Yes

You must make at least one selection.

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