Title IX: Sexual Harassment

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This form is used for an individual impacted by Sexual harassment or Responsible employee to submit a written notification.

Impacted Individual(s): An Impacted Individual(s) is encouraged to report incident(s), but not required to do so. The Title IX Coordinator will review the information and follow-up with the Impacted Individual(s) to discuss College procedures and options related to investigation and resolution.

Responsible Employee: All College employees are Responsible Employees. The Title IX Coordinator will review the submitted information and follow-up with the Impacted Individual(s). The Responsible Employee must notify the student they are required to submit the information to the Title IX Coordinator. Due to confidentiality, the Title IX Coordinator cannot provide information about an individual case's progress or outcomes.

Sexual Harassment Procedures and Policy: https://docs.google.com/document/d/1QAUX5p5dJ9xohk_BsbIrxjgnQ5We3SAQ5vPzgmpKYgM/edit?usp=sharing

Your Full Name (First and Last)

E-Mail

Reporting Individual (First and Last Name) & Status (e.g., student, employee, faculty, vendor, off campus individual)
*

This is the individual that is reporting the information to you or you as the individual that was impacted.

Were there other individual(s) involved? First and Last Name & Status (e.g., student, employee, faculty, vendor, off campus individual)
*

Are you reporting an incident/misconduct/pregnancy or related condition that happened to you or an incident/misconduct/pregnancy or related condition discussed with you?
*

Incident/misconduct happened to me

Incident/misconduct was discussed with me by the reporting individual

Incident/misconduct was discussed with me by someone other than the reporting individual

Other:

When did the reporting individual first discuss the incident/misconduct with you?
*

Please provide specific date and time as possible.

Location of the incident/misconduct
*

Porteous Building

380 Cumberland

49 Oak Street

Oak Residence Hall

Erlang Residence Hall

Monument Residence Hall

Shepley Resident Hall

Off-Campus at a Class

Off-Campus at a College Sponsored Program

Other:

Describe the specific location of the incident/misconduct (room number, floor, and etc.)
*

Time and Date of incident/misconduct

Approximately, if exact time is unknown

Describe the incident/misconduct
*

Does the reporting individual know you contacted the Title IX Coordinator?
*

Yes

Is there any additional information you wish to share?

Submit

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