Title IX Reporting Form

Background/Reporter Information

Please complete this form to the best of your ability. If you are in immediate danger, contact the Public Safety Department at 413-748-5555 or call 911. If you include contact information someone from Title IX will reach out to you.

Your full name (first & last):

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Please leave blank if you would like to file an anonymous report

Your phone number:

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Please leave blank if you would like to file an anonymous report

Your email address:

Email address must be of a valid format.

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Please leave blank if you would like to file an anonymous report

Parties involved(Required):

This field is required.

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This helps to ensure your report is routed to the correct Title IX team member

Date of incident (if known)(Required):

This field is required.

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If unknown, please select today's date

Time of incident (if known):

Location of incident(Required):

This field is required.

Specific location (if known):

Involved Parties

Please identify the party or parties involved in the incident you are reporting.

Name or Organization

Role

ID Number

DOB (YYYY-MM-DD)

Phone number

Email address

Hall/Address

Questions

While providing details is essential to investigating your report, please be advised that some or all of the information you provide in this section may be shared with persons relevant to the incident.

I am(Required)

Complainant (victim) Reporting on behalf of a Complaint (victim) Responsible Employee Witness Other

You must make at least one selection.

I am(Required)

Student Employee Other

You must make at least one selection.

Please describe the incident using as much detail as possible.(Required) This field is required.

Please be specific to identify the people in the incident and their roles (faculty, staff, student, campus visitor).(Required) This field is required.

Please list the names of any witnesses: This field is required.

If you are a Responsible Employee, please enter the date you were made aware of this incident: This field is required.

Supporting Documentation

Please add any additional documents that support your complaint. You will also have the opportunity to provide additional information once you are contacted. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Email me a copy of this report

Background/Reporter Information

Involved Parties

Questions

Supporting Documentation

Submission