Title IX Report Form
Title IX of the Education Amendments of 1972 defines and ensures gender equity in education. The law prohibits all forms of sex or gender-based discrimination in any education program or activity that receives federal funding. Title IX applies to all Andrew College educational programs or activities, including sponsored off-campus programs.

Title IX states:
“No person in the United States shall, on the basis of sex, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any education program or activity receiving federal financial assistance.”
Title IX applies to all employees (administrators, faculty, staff), not just students, at the College.

As a member of the college community, you have a responsibility to report behaviors that potentially constitute sexual or gender based harassment or violence.  When you become aware of an incident or potential incident, where the offender is an Andrew College student, faculty or staff member, you should complete the report immediately.  Even if you are unsure or didn't see the event personally, please fill out this form anyway. This form will be sent to the Title IX/Clery Coordinator.

The Title IX Coordinator, Chicquan Cannon (chicquancannon@andrewcollege.edu), coordinates the College's efforts to comply with and carry out its responsibilities under Title IX.  

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Your Name:
Your position/title at Andrew College is: *
Your Email Address:
Your mailing address/on-campus address:
Your Phone Number:
Third Party (Witness) Name
If you heard (written or verbally) this information third party or witnessed the incident.
Third Party (Witness) Email Address
Third Party (Witness)  Mailing/On-Campus Address
Third Party (Witness ) Phone
Respondent's position/title at Andrew College: *
Respondent's Name:
Respondent's Email Address
Respondent's Mailing/On-Campus Address:
Respondent's Phone Number:
Date of Incident: *
Time of Incident:
Location of Incident: *
Narrative: In your own words, please describe the incident/event including date(s), time(s), location(s), and any potential witnesses. Please be detailed in your description. If you are a third party reporter and do not know details of the actual incident, please describe in detail what was reported to you. *
Please check ALL behaviors alleged to have occurred. *
Required
Are you reporting this incident for yourself or for another person? *
Please indicate other agencies/organizations that have been notified (optional):
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Do you live in the same residence hall as the accused student?
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