Title IX Report Form
Please submit any concern(s) or report(s) that you may have for the Title IX Office below. We can also be reached at
TIX@cmu.edu
.
Please note - this is not an anonymous form. Our office will be in touch with you after receiving your submission to provide information about resources, supportive measures and the option to set up a meeting.
To make a report anonymously, call 877-700-7050 or visit
www.reportit.net
and enter username: Tartans, password: Plaid
* Required
Email address
*
Your email
Are you reporting a concern on behalf of yourself or someone else?
Self
Someone else
Other:
Clear selection
If you are reporting on behalf of someone else, would they be comfortable with an outreach from our office?
Yes
No
Maybe
Other:
Clear selection
Name of Impacted Party (self or someone else) and Andrew ID, if applicable
Your answer
Best Contact Information for Impacted Party
Your answer
Approximate Date of Concern/Incident
Your answer
Is this concern ongoing?
Yes
No
Other:
Clear selection
Which categories apply to your concern(s)? (select all that apply)
Sexual Assault - a physical, sexual act against another person without their consent. This includes a range of acts including unwanted groping, fondling and penetration.
Sexual Harassment - unwelcome conduct or cues of a sexual nature whether verbal/aural (sounds), visual/graphic e.g., pictures and videos), physical, Quid Pro Quo and Hostile Work Environment.
Dating/Domestic Violence - any act or threat of physical or sexual violence made against a dating or sexual partner, spouse or family member.
Stalking - engaging in a pattern of conduct or communications, directed at one person, that causes fear of harm or emotional distress.
Sexual Exploitation - taking sexual advantage of someone without consent, or violating someone’s sexual privacy without consent.
Sex-Based Discrimination - being treated worse in your education or employment on the basis of biological sex; gender identity or expression; and/or sexual orientation.
I'm not sure
Undisclosed
Other:
What additional information would you like to share with the Title IX Office?
Your answer
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