Title IX Reporting Form

Title IX Reporting Form
When to use this form:
1. If any complaint of sexual harassment or assault is made, whether by or against a student or staff; OR
2. Even without a "complaint," the new amendments impose an obligation on K-12 schools to investigate if they "know" regardless of whether there is a complaint:
  - A school has the responsibility to respond promptly and effectively. If a school knows or reasonably should know about sexual harassment or sexual violence that creates a hostile environment, the school must take immediate action to eliminate the sexual harassment or sexual violence, prevent its recurrence, and address its effects.
  - Even if a student/staff or his or her parent does not want to file a complaint or does not request that the school take any action on the student's behalf, if a school knows or reasonably should know about possible sexual harassment or sexual violence, it must promptly investigate to determine what occurred and then take appropriate steps to resolve the situation.
REPORTING OF TITLE IX COMPLAINT
Are making a report for a:*

StudentStaff
Name of Person Filling out this form*
First and Last Name
School/Department*
Date*

MonthDayYear
Date
Name of Victim*
First and Last Name
Name of Alleged Offender*
First and Last Name
Date Incident Occurred*

MonthDayYear
Date
Location of Incident detailed as possible ie room number specific hallway etc*
Please list as many details of the event as possible:
Please upload any statement or any other files that pertain to this investigation.

Cancelof
Should be Empty:

Title IX Reporting Form

REPORTING OF TITLE IX COMPLAINT