Sexual Harassment/Violence Complaint

Background Information

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Your full name:

Your position/title:

Your phone number:

Your email address:

Email address must be of a valid format.

Your physical address:

Nature of Sexual Harassment(Required):

This field is required.

Learn more

May Include Sexual Violence

Date of incident(Required):

This field is required.

Time of incident:

Location of incident(Required):

This field is required.

Specific location:

Involved Parties

Your information will enable the University fulfill its obligations under Title IX to investigate the incident, remedy its effects (if applicable), and prevent its recurrence.

Name or Organization

Select Gender

Select Role

ID Number

DOB (YYYY-MM-DD)

Phone number

Email address

Hall/Address

Questions

Please provide a detailed description of the incident or concern:(Required) This field is required.

Was law enforcement contacted?(Required) This field is required.

Was medical assistance sought?(Required) This field is required.

Please describe the remedy you are seeking (Not all remedies can be granted; however, if a violation of the University's policies have been found to have occurred, an alternative remedy may be implemented):(Required) This field is required.

Has the complaint been pursued through other internal administrative review procedures?(Required) This field is required.

If you answered "yes" to the previous question, please provide the date of the final administrative decision below the level of the President of the University: This field is required.

If the complaint was pursued through internal administrative review procedures, please provide the name of the University official who made the final administrative decision: This field is required.

If the complaint was pursued through internal administrative review procedures, please describe the administrative review procedures and results: This field is required.

Has this complaint been filed with another federal, state, or local agency or court?(Required) This field is required.

If you answered "yes" to the previous question, please provide the agency contact person's name, address, and phone number: This field is required.

How would you like this complaint to be pursued?(Required) This field is required.

I affirm that the above information is true to the best of my knowledge, information and belief.(Required) This field is required.

Supporting Documentation

Please note: You may upload supporting documents here. For sensitive attachments, including photos and videos, OIED can work with you individually to exchange the files. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Would you like to copy other offices on this complaint?

Threat Team: Please check if you have ongoing safety concerns related to this incident.
Care Team: Please check if you are in distress and would like ODU Cares to connect you with resources.

Threat Team

Care Team

Email me a copy of this report

Background Information

Involved Parties

Questions

Supporting Documentation

Would you like to copy other offices on this complaint?

Submission