Confirmation of Title IX Report
Please complete this form if you have witnessed or been made aware of sexual harassment, sexual assault, dating/domestic violence, stalking, and/or gender discrimination. If you suspect abuse or neglect of a minor, immediately contact the Department of Child Protective Services at 1-800-800-5556 to make a report, then complete the Confirmation of DCS Report form.

This completed form will automatically be sent to IPSPD as well as Title IX and Employee Relations as appropriate.
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Email *
Your first name *
Your last name *
Your role *
Required
Date of alleged incident. If more than one date, list most recent date and add other details in incident description at the end of form.
MM
/
DD
/
YYYY
Location of Alleged Incident *
If you selected "other" as the location of incident, please state specific school or location here.
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