Informal Resolution Request Form
As per the Sexual Misconduct Response Policy and Title IX Grievance Policy,  the Title IX Coordinator will assess whether a matter may be resolved through an Informal Resolution Process at the request of either the Complainant or the Respondent any time prior to adjudication. If the Title IX Coordinator determines an Informal Resolution Process may be appropriate, the Coordinator may begin that process after obtaining permission to do so by both the Complainant and the Respondent. At no time will the Title IX Coordinator attempt to mediate a complaint of Sexual Assault – Contact or Sexual Assault - Penetration.

Upon completion of this form, the Title IX office will reach out to you via email.
Email *
Reporting Individual Name *
First Name
Reporting Individual Last Name *
Last Name
Reporting Individual Status *
Required
Date of Incident *
If unknown, you can put an approximate date
MM
/
DD
/
YYYY
Date College Became Aware of Concern
If you notified another Responsible Employee at the College of this incident you may add this date here. If this is your first time notifying the college, leave blank.
MM
/
DD
/
YYYY
Name of Accused *
If unknown, write N/A
Accused's Status *
Required
Location of Incident *
If unknown, write N/A
Have criminal charges been filed with police authorities? *
Description of Incident *
You may include witness information here
Informal Process Request *
Please note, if you elect not to pursue or participate in disciplinary action (as applicable) with the Title IX Office, the College may determine it is necessary to pursue the complaint process without your involvement.  You will be notified if such an action is needed.  In addition, the College may be required to document this report for Clery Act statistics.  The Clery Act requires all colleges and universities that participate in federal financial aid programs to keep and disclose information about crime on and near their respective campuses. No personally identifiable information about you is disclosed in the preparation and publishing of Clery Act reports.
Required
What outcome would you like to see as part of the information resolution? *
A copy of your responses will be emailed to the address you provided.
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