Title IX Complaint Form

Please provide as much detailed information as possible in the Title IX Complaint form below.

Today's Date

Information Regarding the Complainant

Name of Complainant

Complainant's Phone Number

The Complainant is (please select one)

For faculty, staff & students, indicate whether

Information Regarding the Alleged Victim (if he or she is not the Complainant)

Name of the alleged victim

The alleged victim is (please check one)

For faculty, staff & students, indicate whether

Information Regarding the Respondent

Name of the Respondent

Respondent’s phone number (if known)

The Respondent is (please check one)

For faculty, staff & students, indicate whether

Information Regarding the Alleged Misconduct (sexual harassment, sexual violence, domestic violence, dating violence, or stalking)

Date/Time of the alleged Misconduct

Location of the alleged Misconduct

Witnesses or third parties who may have information regarding the alleged Misconduct, along with phone number, if known

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.