Title IX Anonymous Report Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

American Islamic College (AIC) respects the survivor's right to report or not report the alleged incident to the Title IX Coordinator. AIC protects the confidentiality, safety, and privacy of the survivor. AIC prohibits retaliation against the survivor. AIC takes all forms of sexual violence and harassment seriously. This includes domestic violence, dating violence, or stalking, while enrolled at AIC. If you are a survivor or a witness and wish to report anonymously, then, please feel free to fill out an Anonymous Report Form.

Nature of this Report *

Date of Incident *

YYYY

Time of Incident

Time

Location of Incident *

Specific Location

Incident Report

Try to include as many details as possible

Are you the victim or witness?

Victim

Witness

Clear selection

Do you want us to contact you?

Yes

Clear selection

Are you filing this under Title IX?

If yes, please include your email address or phone number

Yes

Clear selection

Phone Number

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of American Islamic College. Report Abuse

Forms