PSR Title IX Complaint Form

Complainant / Respondent/ Responsible Employee Information Name:

This form is used to report any incidents of sexual harassment, sexual misconduct, discrimination, or situations that may involve risk of harm to oneself or others, in accordance with Title IX and PSR policies. Complaints submitted through this form will be handled promptly and confidentially by the Title IX Coordinator or designated staff.

Definitions:
Complainant: The individual who is alleged to have been subjected to sexual harassment or misconduct. Respondent: The individual alleged to have committed the behavior.
Responsible Employee: The employee who is reporting on behalf of a party, please select Reporting Party.

1. Reporter / Complainant / Respondent Information

2. Name

3. Role

Please enter an 'other' value for this selection. * This question is required.

4. Program/Department (If Applicable)

5. Your Phone Number

6. Your Contact Email