TITLE IX Complaint Form

TITLE IX Complaint Form

Complaint Information

T-No

Complaint's Full Name (First Name, Last Name)*

Complaint's Phone Number*

Complaint's Email*

Complainant’s Status*

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University Affiliation*

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For Faculty/Staff, College/ Department Name

Respondent information

Person who engaged in the alleged conduct

Respondent's Full Name (First Name, Last Name)*

Respondent's Phone Number

Respondent's Email

Respondent's Status*

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Describe the alleged Discriminatory Act, Behavior, or Events that occurred. Be as precise as possible about the alleged act/behavior*

When did the Act/Behavior occur?

Is the Act/Behavior currently occurring?*

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How many times did the Act/Behavior occur?*

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Where did the Act/Behavior occur?

Location address, building name, Room number

Were there witnesses to the reported behavior? If so, please list their names and contact information.

Provide names and contact information

Have you reported this conduct to another person or another department? If so, please provide the name and contact information.

Provide names and contact information

Are you interested in an informal resolution?*

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Are you in need of support measures?*

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Supporting Documentation

Upload supporting documents/evidences

Pictures, video, email, text message, social media posts and etc. may be attached. 250MB maximum total size.

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Please Note: A copy of this complaint may be provided to the accused party. However, your university ID and contact information will be redacted. In accordance with federal regulations, the University will keep confidential the identity of any individual who has made a formal complaint under university policy, except as is required under Title IX of the Education Amendments of 1972 or may be permitted by the Family Educational Rights and Privacy Act (FERPA) or as required by law to carry out the purposes of any investigation or hearing under university policy. The University retains the right to charge an individual for making a materially false statement in bad faith during an investigation, proceeding, or hearing under this policy. However, the university will not conclude that any individual has made a materially false statement in bad faith solely based on the outcome of a determination hearing. I have read and understood this document. I affirm my responses in this complaint are accurate to the best of my knowledge and this complaint has been made in good faith.

Complainant's Signature*

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Send me a copy of my responses

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