Title IX / EO

Background Information

Your full name:

Your position/title:

Learn more

Employee, Student, Authorized Volunteer, Guest/Visitor

Your phone number:

Your Email:

Email address must be of a valid format.

Your physical address:

Date of incident(Required):

This field is required.

Time of incident:

Location of incident(Required):

This field is required.

Specific location:

Involved Parties

Name or Organization

Select Gender Assigned at Birth

Select Role

ID Number

DOB (YYYY-MM-DD)

Phone number

Email Address

Hall/Address

Questions

Please describe the alleged incident(s), and when and where it occurred. Also please attach any supporting documentation and evidence.(Required) This field is required.

We highly encourage attempting to resolve complaints informally. Would you be interested in attempting this process? ** If the complaint is an allegation of sexual assault, the System nor the College will allow an informal proceeding to occur.(Required)

Yes No N/A

This field is required.

Disclosure - To investigate your complaint, it will be necessary to interview you, the alleged respondent(s), and any witnesses with knowledge of the allegations or defenses. The statements and the information that you are providing may be attributed to you and could be included in any investigative reports that are prepared. Further, it may be necessary to include you as a witness in any hearing that may occur due to these alleged incidents. Authorization to disclose identity of person reporting incident: *Please note limiting the System and College’s ability to disclose will affect the ability to respond to the complaint.(Required)

Yes No

This field is required.

Please describe your requested remedy for this grievance.(Required) This field is required.

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.

Select copy recipients

Yvette Atencio

Email me a copy of this report

Background Information

Involved Parties

Questions

Supporting Documentation

Select copy recipients

Submission