Discrimination, Sexual Misconduct, and Title IX Reporting Form

Reporter Information

Please provide as much information as possible. This information may be used to contact you to ask further questions, if necessary. You may, however, choose to report this matter anonymously.

Your full name:

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You may type Anonymous for your name so long as you are not a Mandated Reporter.

Your position/title:

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Choices may be: faculty, staff, student or other. For faculty and staff please list your title.

Your phone number:

Your email address:

Email address must be of a valid format.

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If you are member of the campus community please use your university issued email address.

Nature of this report(Required):

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What allegations are being made in this report.

Urgency of this report(Required):

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Indicate how quickly resources resources should be made available to the complainant.

Date of incident(Required):

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If multiple dates, use most recent and provide other dates in narrative. Use today if unknown.

Time of incident:

Location of incident(Required):

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Specific location:

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For example, if incident occurred in the Glenn Building, where in the Glen Building.

Individuals Involved

Please list the individual(s) involved, including the parties and any witnesses or bystanders. Select as many fields with information about the individual(s) as you can. Please note that in order to adequately respond to reports, it is important to include the names of both complainants and respondents.

First and Last Name

Select Role

Phone number

Email address

Residence Hall location and number or off campus address

Questions

Please provide a detailed description of the incident using specific, concise, objective language (who, what, where, when, why and how).(Required) This field is required.

If you are self-submitting this report as the complainant, do you wish for this report to serve as a formal Title IX complaint to initiate the grievance process and/or informal resolution process related to the allegations that have been reported? Please note this question is only relevant to Title IX applicable misconduct (sexual assault, sexual harassment, dating violence, domestic violence, and stalking) as outlined in the Transylvania University Equal Opportunity, Harassment, and Nondiscrimination policy.

Yes I do not know at this time

You must make at least one selection.

If you indicated "yes" to the above question, type your name below to confirm, "I am the Complainant making a Formal Complaint under Title IX." This field is required.

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Reporter Information

Individuals Involved

Questions

Supporting Documentation

Submission