Sexual Misconduct Title IX Complaint Form
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Today's Date
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Information Regarding the Complainant
Name of the Complainant *
Email of the Complainant *
Complainant’s Phone Number
The Complainant is (please check one)
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For faculty, staff, & students, indicate whether
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Information Regarding the Alleged Victim
(if he or she is not the Complainant)
Name of the alleged victim
The alleged victim is (please check one)
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For faculty, staff, & students, indicate whether
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Information Regarding the Respondent
Name of the Respondent
Respondent’s phone number (if known)
The Respondent is (please check one)
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For faculty, staff, & students, indicate whether
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Information Regarding the Alleged Misconduct (sexual harassment, sexual violence, domestic violence, dating violence, or stalking)
Time of the alleged Misconduct
Time
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 Date of the alleged Misconduct
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DD
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Witnesses or third parties who may have information regarding the alleged Misconduct, along with phone number, if known
Please provide a brief description of the alleged Sexual Misconduct You may wish to consider including, among other things, some or all the following information in your description: the gender of the parties, the relationship between the parties, whether one or more of the parties were under the influence of alcohol or drugs at the time of the alleged Misconduct, whether the Respondent used pressure or force (physical or otherwise) in the course of the alleged Misconduct, and the frequency (if applicable) of the alleged Misconduct.
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