SBVC - Title IX: Sexual Harassment/Discrimination Reporting Form

Reporter Information

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Your full name:

Your position/title:

Your phone number:

Your email address:

Email address must be of a valid format.

Your physical address:

Nature of this report(Required):

This field is required.

Date of incident(Required):

This field is required.

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If you do not know the exact date, you can provide a time range in your narrative.

Time of incident:

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If you do not know the exact time, you can provide a time range in your narrative.

Location of incident(Required):

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Specific location:

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Include extra information or other descriptor

Involved Parties/Witnesses

Please list the individuals involved (excluding yourself), including as many of the listed fields as you can provide.

Student/Witness Name

Select Gender

Select Role

ID Number

DOB (YYYY-MM-DD)

Phone number

Email address

Address

Provide details of incident

Supporting Documentation

Please identify and attach any documents or other evidence regarding the alleged acts, such as e-mails, correspondence, text messages, social media posts, or other materials. 1GB maximum total size. Attachments require time to upload, so please be patient after submitting this form. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Reporter Information

Involved Parties/Witnesses

Provide details of incident

Supporting Documentation

Submission