Discrimination, Harassment, and Sexual Misconduct Report Form

Spartanburg Methodist College (SMC) does not tolerate discrimination or harrassment on the basis of an individual's protected characteristics, sexual misconduct, sexual harassment, relationship violence, stalking, or unequal access to SMC's program or facilities. SMC has an expectation that employees and students will share information they receive regarding these behaviors.

The office of Title IX and Equal Opportunity's Discrimination, Harassment, and Sexual Misconduct report form gives you the opportunity to notify SMC of any concerns you have related to these issues.

Once submitted, this report is sent to the office of Title IX and Equal Opportunity/ Title IX Coordinator. SMC makes every effort to protect privacy and confidentiality. Information submitted will be shared only on a need to know basis. If you wish to remain anonymous, do not provide identifiable information; however, please note that it may limit SMC's ability to investigate the matter.

Title IX Report Form

1. Reporting Individual's Name

2. Reporting Individual's Status

Other (Please specify)

3. Phone Number

Format: (000) 000-0000.

4. Your Email Address

example@example.com

5. Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

6. Nature of this report?

If Other, please describe below.

7. Date of incident?

8. What time did the incident occur?

9. Location of incident?

What was the specific location? (i.e room number, etc.)

Involved Parties

Please list the person(s) involved in this report.

Complainant: individual to whom the misconduct was directed

Respondent: individual who may have violated college policy

The information you provide will enable SMC to fulfill its obligations under federal law, to investigate the incident, remedy its effects and prevent its recurrence.

10. Are you the complainant (the individual to whom the misconduct was directed?

Select role.

11. If you chose no, please list the individual whom the conduct was directed towards?

12. Who is the individual who may have violated institutional policy (the "respondent")?

Select role.

13. Were there any witnesses to the incident? If so, please list them below. If no, please write no.

14. Please provide a detailed description of the incident or concern.

15. Please describe the remedy, resolution, or interim measure you are seeking or requesting.

16. How would you like this report to be pursued?

17. Has the report been submitted to other offices on campus for assistance?

If yes, please provide information regarding the offices this report has been submitted.

18. Was law enforcement contacted?

If yes, please provide the agency name.

19. Was medical assistance sought?

I affirm that the above information is true to the best of my knowledge and belief.

Discrimination, Harassment, and Sexual Misconduct Report Form

Incident Specific Information