Print
Press Enter to show all options, press Tab go to next option

Title IX Complaint Form

Please correct the field(s) marked in red below:

Please provide as much detailed information as possible in the Title IX Complaint form below. 
If you are having trouble submitting the form below you may download a printable version of the form and email it to titleixcoordinator@vhcc.edu.
1
Today's Date:
2
Information Regarding the Complainant:
Information Regarding the Complainant:
3
The Complainant is (please select one):
The Complainant is (please select one):
4
For faculty, staff & students, indicate whether:
For faculty, staff & students, indicate whether:
5
Information Regarding the Alleged Victim (if he or she is not the Complainant):
6
The alleged victim is (please check one):
The alleged victim is (please check one):
7
For faculty, staff & students, indicate whether:
For faculty, staff & students, indicate whether:
8
Information Regarding the Respondent:
Information Regarding the Respondent:
9
The Respondent is (please check one):
The Respondent is (please check one):
10
For faculty, staff & students, indicate whether:
For faculty, staff & students, indicate whether:
11
Information Regarding the Alleged Misconduct (sexual harassment, sexual violence, domestic violence, dating violence, or stalking):
Information Regarding the Alleged Misconduct (sexual harassment, sexual violence, domestic violence, dating violence, or stalking):
12
Location of the alleged Misconduct:
Location of the alleged Misconduct:
13
Witnesses or third parties who may have information regarding the alleged Misconduct, along with phone number, if known:
Name Phone number (if known)
1
2
3
4
5
6
14
Please provide a brief description of the alleged Sexual Misconduct: 
You may wish to consider including, among other things, some or all the following information in your description: the gender of the parties, the relationship between the parties, whether one or more of the parties were under the influence of alcohol or drugs at the time of the alleged Misconduct, whether the Respondent used pressure or force (physical or otherwise) in the course of the alleged Misconduct, and the frequency (if applicable) of the alleged Misconduct.
  1. To receive a copy of your submission, please fill out your email address below and submit.