Title IX Report Form
Use this form to make a Title IX complaint.
What is the nature of your report?
*
Type a short summary of the complaint.
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
SEBTS ID number:
Relationship to SEBTS:
*
i.e., student, faculty, staff, etc.
Urgency of this report:
Are you safe? Are you where you cannot be hurt further?
Date of incident:
-
Month
-
Day
Year
Date
Approximate time of incident:
Location of incident:
Where did this incident take place?
Did any injuries occur:
Who does this complaint concern?
Name of respondent/suspect
Nature of the incident (check all that apply):
Sexual assault
Sexual misconduct
Sexual harassment
Stalking
Other
If "other," short explanation:
Brief summary of incident:
Additional, relevant files:
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Submit
Should be Empty: