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Title IX/Sexual Misconduct Reporting Form

This form should be used to report an incident involving an alleged violation of the Title IX/Sexual Misconduct Policy (including any form of sex discrimination, sexual harassment, sexual assault, dating violence, domestic violence, and/or stalking). This report form can be utilized by Wittenberg University community member wishing to file a report on their own behalf or by anyone wishing to file a report on behalf of a Wittenberg University community member.

Please note that all faculty members, staff members, and administrators, with the exception of those working in a confidential capacity (e.g., counselors, rape crisis advocates, medical providers, and clergy) are expected to report any disclosures that involve allegations of sex discrimination, sexual harassment, sexual assault, domestic violence, dating violence or stalking. To learn more please visit the Student Handbook.

If there is immediate risk to health or safety, please contact Wittenberg Police at 937-327-6363.

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.

Nature of this report(Required):

This field is required.

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

Select Role

ID Number

DOB (YYYY-MM-DD)

Phone number

Email address

Hall/Address

Narrative Information/Notifications

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.

Background Information

Involved Parties

Narrative Information/Notifications

Supporting Documentation

Submission