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Title IX Incident Report
This form is designed to report a violation of Title IX. We appreciate any contact information you are willing to provide. You are welcome to remain anonymous if desired. If you have any documentation of the incident (e-mails, letters, pictures etc), please turn those in to our Title IX coordinator, Steve Hudman. His office is located in the Student Center, Room 101.

By completing this form, you acknowledge that you are initiating a complaint which will be investigated per Angelina College policy. You certify that the following information is accurate to the best of your knowledge. Please contact the local authorities if you need immediate assistance by dialing 911.

Name (you may stay anonymous if preferred)
Your answer
Address
Your answer
E-mail:
Your answer
Phone Number:
Your answer
Name of the individuals(s) involved in the incident:
Your answer
I am a (please check one):
Is this report related to:
Description of the Incident - Please list dates/time/location and what occurred.
Your answer
Witnesses - Please list anyone that you believe could provide information regarding your complaint. Please include contact information for those individuals if possible:
Your answer
What action would you like Angelina College to take following the receipt of this complaint?
Your answer
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