Era ISD: Report Sexual Misconduct (Title IX)
Please use this form to report sexual misconduct, sex discrimination, gender-based discrimination, sexual harassment, sexual assault, domestic violence, dating violence, stalking, sexual exploitation or other Title IX related allegations. Please type "not known" in any required question that you cannot or do not want to answer.
REPORTING PARTY
This form is designed to provide students, employees, faculty, vendors, visitors or others with an on-line method to report sexual misconduct. You are not required to complete the entire form in order for a complaint to be submitted. The District will use the information provided to begin an investigation, which may include contacting the alleged victim, alleged perpetrator and/or any potential witnesses. However, if the report does not contain specific information, the District's response may be limited.
Please type your full name:
Your position/title:
Your phone number:
Your email address:
Urgency of this report: *
Questions Regarding the Incident
Date of Incident: *
MM
/
DD
/
YYYY
Time of Incident:
Time
:
Description of Incident *
Location of Incident (please be specific) *
Witnesses: please include any known contact information including e-mail, phone numbers, or other ways to contact the witness(es). *
Other Involved Parties - for each party, please include the following if known: Name, Gender, any known Contact information including e-mail, phone numbers, or other ways to contact, and the Role of each person in this incident [alleged victim (complainant), or alleged perpetrator (respondent), or witness] *
Please type your name below to indicate your electronic signature for this report. If you are not an Era ISD employee and are making an anonymous report, you can type anonymous for signature. Era ISD employees who are not employed in a designated confidential office should under Texas state law include your name. *
If you are a complainant and wish to designate your report as confidential, please check the appropriate box below. The District will do its best to honor the victim/survivor's request for confidentiality, however, confidentiality is not guaranteed. Most Era ISD employees are considered "responsible employees" meaning they are mandated to report Title IX allegations. While a victim/survivor’s conversation will be kept private (will not be shared unnecessarily with others), only a conversation with a confidential resource can be kept confidential (will not be shared with anyone without the express consent of the victim/survivor). *
If you have any supporting evidence that you wish to include at the time of this report, please click "Yes" below and attach those documents to an email addressed to superintendent@eraisd.net. An Investigator will contact you to gather more information as appropriate. *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Era ISD. Report Abuse
Google Forms