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Title IX Reporting Form

This form is only to be used for the reporting of Title IX issues, which typically are of a sexual nature. For other crimes or security/safety concerns, please use the Campus Security Authority (CSA) Reporting Form.

Reporting Person Contact Information
Reported By:*
- The Victim
- A Third Party
If a third party reported the crime to you, please enter the relationship of the third party to the victim:
Name*
First Last
Phone Number*
Email Address:*
Agency Notified
To your knowledge, was a law enforcement notified?*
- Yes
- No
Please enter the name of that agency:*
Does the victim want the incident reported to law enforcement?
- Yes
- No
Incident Information
Please note that sex offenses, domestic violence, dating violence, and stalking are reportable offenses under Clery Act. The information listed bellow is helpful in determining which incidents are reportable under both the Clery Act and Title IX.
Name of the person who experienced sexual violence?
( If known)
First Last
Location of incident
Building Name Street Address/Office Number City State / Province / Region ZIP / Postal Code
Date of Incident*
MM slash DD slash YYYY
Time of Incident
(If known)

Hours :

Minutes

AM/PM
Incident Description*
(Please provide specific, detailed information)
If you have any additional attachments, please upload here:
Max. file size: 100 MB.
Name of Alleged Perpetrator
(If known)
First Last
Other Student(s) Involved in the Incident:
Location
What best describes the location of the incident?*
( If the incident occurred in multiple places, check all that apply.)
- On Campus, residence hall
- On Campus, not in a residence hall
- Public property immediately adjacent to cmapus
- Non-campus in a University owned leased or controlled space ( fraternity, sorority, off-campus classroom)
- Unknown location, other
- I do not know which category this would fall under
Geography Definition: On campus
Any building or property owned or controlled by an institution within the same reasonably contiguous geographic area and used by the institution in direct support of, or in a manner related to, the institution’s educational purposes, including residence halls; and
Any building or property that is within or reasonably contiguous to the area identified in paragraph (1) of this definition, that is owned by the institution but controlled by another person, is frequently used by students, and supports institutional purposes (such as food or other retail vendors)
Geography Definition: Public Property
All public property, including thoroughfares, streets, sidewalks, and parking facilities, that is within the campus, or immediately adjacent to and accessible from the campus.
Geography Definition: Non-campus building or property
Any building or property owned or controlled by a student organization that is officially recognized by the institution; or
Any building or property owned or controlled by an institution that is used in direct support of, or in relation to, the institution’s educational purposes, is frequently used by students, and is not within the same reasonably contiguous geographic area of the institution
Please Describe Location to the Best of your Abilities:*
Please Review the information within the form, and submit when completed.

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See Also

HCU Title IX Policy
Campus Security Authority (CSA) Reporting Form
Title IX Training

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