Title IX Incident Report Form

This form should be used to report of violations the Policy Prohibiting Sex and Gender-Based Discrimination, Sexual Misconduct and Retaliation (Title IX Policy). The Title IX Policy prohibits behaviors such as gender-based discrimination, dating violence, domestic violence, sexual assault, sexual exploitation, sexual harassment, stalking, retaliation, or consensual relationships between employees and students.

Please note every University employee is considered a Responsible Employee and is required to report any information regarding a known or suspected violation of this policy. The Title IX Office respects the sensitivity of the information that may be included in this form. Information included in this form is not confidential but will be kept as private as possible to protect individuals and the greater University community. Information may be shared with limited University employees who need to know to assist in the assessment, investigation, and resolution of the report and related issues.

If you are unsure of what to report or would like to speak to someone about completing this report form, please call the Title IX Office at 202-274-2306.

Please provide us with as much information as possible. We may contact you to ask further questions, if necessary. Except for Responsible Employees, as described above, you may report this matter anonymously.

Your Full Name:*

First NameLast Name

Your position/title:

Your phone number:*

Please enter a valid phone number.

Your email address:*

Your UOTP email address

Date of incident (Required):*

Date

Time ofincident:*

Hour Minutes

AM/PM Option

Location of incident(Required):*

Please provide us with as much information as you can about the people involved in this incident.

Definitions:

Complainant - An individual who is alleged to have experienced Prohibited Conduct.

Respondent - An individual who has been reported to have engaged in Prohibited Conduct.

Witness - An individual who may have information relevant to a report of Prohibited Conduct. A witness may be a student, an employee, or a third party.

Name or Organization:*

Gender:*

Select Role:*

ID Number:

Phone Number*

Please enter a valid phone number.

Email Address:*

example@example.com

Add another party

Name or Organization:*

Gender:*

Select Role:*

ID Number:

Phone Number*

Please enter a valid phone number.

Email Address:*

example@example.com

Description of incident and questions

Please provide a description of the incident. Provide as many details as possible to assist with the investigative process. If you are reporting multiple incidents (example: a pattern of stalking behaviors), please begin with the most recent incident. (Required)

Is any other office or mandatory reporter aware of this incident? (e.g.Has the Complainant sought assistance from another department? Was a report made in addition to Title IX?)*

Supporting documentation

Please include any relevant documentation (e.g., email attachment, image, document, etc.) if applicable. 5GB maximum total size.

Title IX Incident Report Form

Reporting Party information

Involved Parties

Involved Party: