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Sex Discrimination and Sexual Harassment Reporting Form


If you navigated to this page because you were subjected to, or wish to report an incident of, sexual harassment and/or sex discrimination (sexual harassment, sexual assault, gender-based harassment, dating violence, domestic violence, stalking, and adverse treatment based on pregnancy or parenting status), please consider reading and completing this form. More important than your decision to complete this form, however, is the activation of support for you and others affected. While anonymous reports can be made using this form, please note that we are unable to follow-up with impacted persons with support resources without a name, nor may the University be able to take action against a respondent without an identified complainant. As such, we know reporting can be intimidating so we welcome you to contact the Dean of Students Office at 336-334-5514 or the Title IX Office at 336-256-0422 during business hours (8:00am - 5:00pm) so that we may provide you with support options even if you decide not to complete this form. In an emergency, (regardless of the hour) call UNCG Police at 336-334-4444.

This form should be used by any person to report an incident involving an alleged violation of the UNCG Title IX Policy (sexual harassment, sexual assault, gender-based harassment, dating violence, domestic violence, stalking, and adverse treatment based on pregnancy or parenting status). This report form can be utilized by students, faculty, staff or others wishing to file a report on their own behalf or by anyone wishing to file a report on behalf of any aggrieved person. Once completed, this form is routed to the following offices for review and as such, you may receive communication from them: The Dean of Students Office, The Title IX Office, Clery Compliance Officer, & Office of Student Rights and Responsiblities.

If you are experiencing an emergency, or if there is an imminent risk to your well-being or that of another person, contact UNCG Police at 336-334-4444. If you are off-campus, call 911.

This form does NOT automatically initiate a Student Code of Conduct Process. This form provides you with an opportunity to inform the Dean of Students Office and the Title IX Office of your experience and to receive resources and support. Should you wish to file a complaint against a current UNCG student, you may choose to use the report generated by this form as your "Complaint Form" or you may choose to augment your Complaint Form with additional information in the future.

**Information submitted through this form outside normal business hours (8:00am - 5:00pm) may not be reviewed until the next business day.**



For information on confidential reporting options, please visit Sexual Harassment Support & Reporting Options.

Background Information of the Person Submitting this Report

UNCG strongly encourages all good-faith reports, and will respond to all reports based on the nature and quality of the information that is shared. UNCG wishes to support you and others affected by the contents of this report. The university understands, however, that there may be reasons why you might choose to withhold your identity or other portions of the narrative now, or indefinitely.

Anonymity: You may wish to identify yourself through the fields in this section, or you may elect to remain anonymous. You may choose to identify yourself in the future or not. Be advised that any information included in this report may be shared with the person(s) whose behavior is being reported.

Notes: (1). Click on the question mark icon for more information about the field before it. (2). Only the fields with red asterisks are required for successful form submission.

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You may type ANONYMOUS here if you wish to remain anonymous.
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LEAVE BLANK FOR ANONYMITY
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LEAVE BLANK FOR ANONYMITY
Email address must be of a valid format.
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LEAVE BLANK FOR ANONYMITY
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LEAVE BLANK FOR ANONYMITY
This field is required.
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Please refer to UNCG Title IX Policy for full description.
This field is required.
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If you do not know the exact date, offer your best guess and explain further in your narrative
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If you do not know the exact time, you can provide a description of a time range in your narrative
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Include extra information such as a room number or other descriptor

Involved Parties

Please list the individuals involved (including witnesses), including as many of the listed fields as you can provide.

Involved party 1

Narrative Description of Incident(s)

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.

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