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Student Complaint Form Regarding Sex Discrimination Under Title IX (other than sexual harassment) form
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* Indicates required question
Name of complainant
*
Your answer
Date of the complaint
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MM
/
DD
/
YYYY
Date of the alleged sex discrimination
*
MM
/
DD
/
YYYY
Name or names of the sex discriminator(s)
*
Your answer
Location where such sex discrimination occurred
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Your answer
Name(s) of any witness(es) to the sex discrimination
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Your answer
Detailed statement of the circumstances constituting the alleged sex discrimination
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Your answer
Remedy requested
*
Your answer
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