Title IX Formal Complaint

Date/time of incident*

:

Incident Location*

Campus Building Campus Outdoors Off Campus Organization House Huntington University Sponsored Event

Respondent Affiliation *

Undergraduate Student Graduate Student Faculty Staff Alumni Guest

Other:

Name of Respondent (optional and not required)

First Name

Last Name

Phone of Respondent (if known)

Email of Respondent (if known)

Type of Incident*

Discrmination Harassment Violence Retaliation Other

Social Media Accounts Involved (optional and not required)

Facebook Twitter Instagram Snapchat Tik Tok YouTube

Other:

List any Social Media accounts involved in this incident

Witnesses (optional and not required)

List all witnesses. Please include names, phone numbers, emails of any witnesses

Incident Narratve (this can be brief: a full narrative will be taken by an investigator)*

Accommodations

I request accommodation(s) for a qualified disability I do not request accommodation(s) for a qualified disabilty

Other:

Resolution Requested*

Formal Resolution (Investigation and Hearing) Informal Resolution No Action

Huntington University Title IX Formal Complaint