Report Sexual Harassment or Interpersonal Violence to the Title IX Office
This form is for submitting information regarding violations of the University's Sexual Harassment & Interpersonal Violence Policy to the Title IX Office. This is NOT for 911 or Emergency Service. Do not use this form to report events that present an immediate threat. If you require emergency assistance, please call the John Carroll University Police Department at 216.397.1234 or the University Heights Police Department at 911.

You may file this report anonymously unless you are a university employee with reporting obligations. If you are unsure of whether you have reporting obligations, you may review the policy at Please be aware that filing anonymously may limit the University’s ability to respond to your concerns and that if you are a responsible employee, you must identify yourself when completing this form.

Any intentional misuse of the John Carroll University Title IX Reporting System to cause harm to another person or group is subject to review under our Community Standards, codes of conduct, and/or other policies. Your completed reporting form will be sent directly to the John Carroll University Title IX Coordinator and a copy will be forwarded to your email, as designated below.
Name (First & Last)
My primary role at the University is: *
My role in filing this report is: *
E-mail Address
Phone Number
Preferred method of contact: *
Date of the incident (if known)
Role of the Respondent (person alleged to have committed the violation) *
Location of the incident (if known):
Please describe the incident or concern: *
If you are a Responsible Employee, Witness, or Third-Party Reporter, did you ask the Complainant (person targeted by the behavior) if they wish to make a formal complaint requesting that the University take some action? *
All reports will be handled with concern for the privacy of those filing reports and those identified in the report. However, the Title IX reporting system is NOT a confidential reporting option. Your completed form will be sent directly to the University’s Title IX Coordinator.

Confidential reporting options are reports made to individuals who, because of their professional status, are prohibited by law from revealing a reporting person’s identity or facts of a conversation, unless an imminent threat to the individual or others exists.

JCU has a number of confidential reporting sources available to members of the University community, including the University Counseling Center, the University Health and Wellness Center (including Doctors or Nurses acting under a Doctor’s direction), ordained members of the clergy engaged in pastoral counseling, or the licensed providers available through the University’s employee assistance program.

If you wish to make a confidential report, please report the issue to a confidential reporting option. These confidential reporting options can discuss options available to you for reporting in a non-­confidential manner, such as the Title IX Reporting System, if you wish to do so
Never submit passwords through Google Forms.
This form was created inside of John Carroll University. Report Abuse