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Title IX and Sexual Discrimination Report

If you want more information regarding Title IX go to

www.muskegoncc.edu/titleIX

Your Information

Your full name:

Your position/title:

Your phone number:

Your email address:

Email address must be of a valid format.

Your physical address:

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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Room number or Office/Room Name

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 a Drivers License number if available in the block labeled SID.

Involved party 1

Name

Select Role

Student ID Number or Driver's License Number

DOB (YYYY-MM-DD)

Phone number

Email address

Hall/Address

Report

Please provide detailed information regarding the incident you are reporting.(Required) This field is required.

Reasons for the Report(Required)

Harassment

Sexual Harassment

Sexual Assault

Sexual Misconduct

Stalking

Threats and Intimidation

Dating Violence

Domestic Violence

Retaliation

Inapproriate behavior

Other

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.

Submission

Email me a copy of this report