Title IX Reporting Form | Helms College

enter location Role

Date and Time of incident

Date

Time

Location of incident: *

Specific location:

Involved Parties

Name *

First

Last

Phone *

Email *

Select Role *

Do you need to add another involved party? *

Yes
No

Name (Involved Party 2) *

First

Last

Phone (Involved Party 2) *

Email (Involved Party 2) *

Select Role (Involved Party 2) *

Questions

What best describes the location of the crime? (If the crime occurred in multiple places, please check all that apply.) *

On campus
Off campus
Public property immediately adjacent to campus
Unknown location, other
I do not know which category this location this would fall under

Who was this incident reported by? *

Victim
Third Party
Anonymously

If a third party reported the crime to you, please enter the relationship of the third party to the victim.

If, to your knowledge, a law enforcement agency was notified, please enter the name of that agency.

Does the victim want the incident reported to law enforcement? *

Yes
No

Incident Description (Please provide specific, detailed information.) *

Incident Category (Select all that apply) *

If you selected a Hate Crime category above, please indicate the type of bias. (Select all that apply) *

Other Crime Category (If the crime was not listed above, please enter the additional crime category.)

Was damage done to the property?

Yes
No

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size. Attachments require time to upload, so please be patient after submitting this form.

Click or drag files to this area to upload. You can upload up to 5 files.

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