REPORT OF SEXUAL MISCONDUCT

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Directions: Please complete all sections of this form and electronically sign affirming your statements. This form will be submitted to the Title IX Coordinator. For student allegations, the form is submitted to jonpaul.burden@weldre4.org. For staff allegations, the form is submitted to nikki.schmidt@weldre4.org

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Email *

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Name of Person Filing Complaint: *

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School/Department Name: *

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Complainant Contact Phone Number *

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Complainant Email *

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Name of Student/Staff experiencing alleged harrassment *

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