SJCON Title IX Confidential Reporting Form

Title IX prohibits discrimination, harassment, and retaliation of any kind on the basis of sex. Title IX also
prohibits Violence Against Women Act offenses (“Sexual and Interpersonal Offenses”) such as sexual
assault, sexual misconduct, sexual violence, domestic violence, dating violence, and stalking. Any person,
regardless of gender, can be a victim/survivor of a Title IX violation.

*The complainant does not have to be the same indivduals who completes the form*
Title IX Confidential Reporting Form completed by Title IX Confidential Reporting Form completed by First Last
Your position/title at the College

Your position/title at the College Faculty Staff Student
Incident Date Incident Date / MM / DD YYYY
Incident Time Incident Time : HH MM AM/PM
Email
Please provide the following information about the involved parties:

Complainant - individual who is making the complaint
Respondent - individual who is being reported to be the alleged perpetrator of conduct that could constitute Title IX Sexual Harassment
Complainant Name Complainant Name First Last
Position/title at the College

Position/title at the College Faculty Staff Student
Respondent Name Respondent Name First Last
Position/title at the College

Position/title at the College Faculty Staff Student
Description of Incident
Complainant

Complainant I would like to file a formal Title IX report. I WOULD NOT like to file a formal Title IX report.

SJCON Title IX Confidential Reporting Form

SJCON Title IX Confidential Reporting Form

*The complainant does not have to be the same indivduals who completes the form*

Please provide the following information about the involved parties: Complainant - individual who is making the complaint Respondent - individual who is being reported to be the alleged perpetrator of conduct that could constitute Title IX Sexual Harassment

The complainant does not have to be the same indivduals who completes the form

Please provide the following information about the involved parties:

Complainant - individual who is making the complaint
Respondent - individual who is being reported to be the alleged perpetrator of conduct that could constitute Title IX Sexual Harassment