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Sexual and Gender-Based Harassment and Misconduct Reporting Form


This form should be used to report any incident involving an alleged violation of the Rollins College Sexual and Gender-Based Harassment and Related Misconduct Policy, which includes sexual or gender-based harassment, sexual assault, interpersonal violence, stalking, and other forms of sexual and gender-based misconduct or discrimination.

Please note that submissions using this form may not be reviewed outside of normal business hours. If there is an immediate risk to health or safety, please call 911 or contact Campus Safety at 407-646-2999.

Rollins College takes incidents of sexual and gender-based harassment and misconduct seriously and is required to investigate allegations of to the best of its ability. By submitting this report, you are stating that all information contained in the report is true and correct to the best of your knowledge. Knowingly providing false information may result in disciplinary action. The College prohibits retaliation for making a good faith report of sexual or gender-based harassment and misconduct. Retaliation should be reported immediately to the Office of Title IX.



All faculty and staff, with the exception of those in the Wellness Center and the Dean of Religious Life, are obligated to report information to the Office of Title IX (407-691-1773 or titleix@rollins.edu ) if they receive notice of an incident of sexual or gender-based harassment or misconduct. Responsible employees must not submit this form anonymously. Student reporters or reporting parties may remain anonymous; however, the College may be limited in its ability to respond to anonymous reports where the identity of those involved is unknown.

 
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Faculty, staff, student, alumni, third-party contractor, visitor, parent, unaffiliated, etc.
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There is no time-limit for reporting. If unknown, list date you learned of incident.
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Select a time of day to the best of your knowledge.
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Room/office number or other information.

Involved Parties

Please share information about any individuals involved in the incident.



Reporting party refers to any person(s) who may have been subjected to harassment or misconduct.

Responding party refers to the person(s) or organization accused of committing harassment or misconduct.

Witness refers to any person(s) who may have directly observed an incident or have direct or indirect knowledge related to an incident of harassment or misconduct.

Involved party 1

Incident Information

Please help us understand as much as possible about the individual(s) or organization involved and what occurred.

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To your knowledge, was this incident reported to a police or law enforcement agency?(Required)
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Have any other departments been notified (check all that apply)?(Required)
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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.

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