Title IX Complaint History Form
Please provide your Title IX complaint history. This form is designed to collect relevant information in a secure and approachable manner.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Institution(s) Where Complaints Were Filed
*
How many Title IX complaints have you previously filed?
*
Approximate Date(s) of Complaint(s)
Type of Complaint(s)
*
Sexual harassment
Sexual assault
Discrimination based on sex
Retaliation
Other
Current Status of Complaint(s)
Please Select
Open
Closed
Under investigation
Resolved informally
Other
Outcome(s) of Complaint(s)
Additional Comments (optional)
Submit History
Should be Empty: