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Title IX Sexual Harassment Reporting Form

Title IX Sexual Harassment Report Form

This form may be used to report an incident of Title IX Sexual Harassment by an individual harmed by a violation of the Title IX Sexual Harassment Policy or by third-parties who would like to report an incident. This report does not automatically result in the filing of formal complaint, which may only be filed by a person individually harmed by a violation of the Title IX Sexual Harassment Policy or the Title IX Coordinator. Completion of this form does NOT begin any formal investigation under Title IX, but will allow the Title IX Coordinator to contact the individual concerned. Often, the Title IX Coordinator will be able to offer supportive measures, provide information and answer questions about the process, and assist members of the campus community in accessing appropriate resources. All of these steps are independent of any formal complaint process, and members of the campus community are able to decide what resources and filing decisions are best for the unique circumstances of the individual campus community member.
  • Title IX Sexual Harassment includes, but is not limited to, sexual harassment, sexual assault, dating violence, domestic violence, stalking, and the unauthorized distribution of sexual images or recordings by any faculty member, staff member, student, or a third party who is a participant in a university-sponsored program, event, or activity or the violation occurs at a location which the University exercises substantial control (RSO buildings, Greek housing, off-campus University housing, etc). If you believe you have been harmed by a violation of the Title IX Sexual Harassment Policy or you know of someone who has been harmed, please complete this form. The information is sent directly and securely to the Title IX Coordinator once the form is completed and the user selects "submit."

  • Information Regarding the Reporter

  • Person making the report to UCA. This may be anonymous. Field must be complete, but can state "unknown."
  • Field must be complete, but can state "unknown."

  • Information Regarding the Complainant (person individually harmed by a violation of the Title IX Sexual Harassment Policy) if different than Reporter

  • Field must be complete, but can state "unknown."
  • Field must be complete, but can state "unknown."

  • Information Regarding the Respondent (person alleged to have violated Title IX Sexual Harassment Policy)

  • Field must be complete, but can state "unknown."
  • Field must be complete, but can state "unknown."
  • Field must be complete, but can state "unknown."

  • Information Regarding the Alleged Title IX Sexual Harassment

  • :
  • Field must be complete, but can state "unknown."
  • 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 Sexual Misconduct, whether the Respondent used pressure of force (physical or otherwise) in the course of the alleged Sexual Misconduct, and the frequency (if applicable) of the alleged Sexual Misconduct.