Directions for the completing the form: Review the attached checklist to ensure you are discussing the items with any victim of sexual misconduct. The items do not need to be discussed in any particular order, but are arranged in a manner that can help you with your discussion. Fill in the fields as requested name, date, etc. – Complainant is defined as the individual who has been impacted or targeted by the sexual misconduct. – If you are a member of the staff at Student Health Services, the Counseling Center, Faculty Staff Assistance Program (FSAP), or Sexual Offense Support (S.O.S.), the need not be complainant’s name included on this form but you can include the affiliation to UD, such as undergrad, staff, complainant’s faculty, graduate student, vendor, etc. Anyone else completing this form must include the complainant’s name, if known. Against Whom - If the complainant reveals the name of the alleged perpetrator, and you are not a member of the staff at Student Health Services, the Counseling Center, FSAP, or S.O.S., you must include that information here. You should maintain privacy of the alleged name and not perpetrator’s share it with anyone. If the complainant does not reveal the name of the alleged perpetrator, other types of information can be noted such as the affiliation to UD, if the perpetrator is a student at individual’s another school, a visitor, a vendor, etc. Description of the Incident try to get as much information about the events that happened (as revealed – by the complainant) such as the circumstances of the conduct, what conduct was disturbing and how, names of witnesses or others involved, etc. Refrain from judgment and describe the facts that were told to you or that you witnessed. to a Deputy Title IX Coordinator (as listed above) or to the University Title IX Coordinator, Email the form Susan Groff (information above).
Directions for the completing the form: Review the attached checklist to ensure you are discussing the items with any victim of sexual misconduct. The items do not need to be discussed in any particular order, but are arranged in a manner that can help you with your discussion. Fill in the fields as requested – name, date, etc. Complainant – is defined as the individual who has been impacted or targeted by the sexual misconduct. If you are a member of the staff at Student Health Services, the Counseling Center, Faculty Staff Assistance Program (FSAP), or Sexual Offense Support (S.O.S.), the complainant’s name need not be included on this form but you can include the complainant’s affiliation to UD, such as undergrad, staff, faculty, graduate student, vendor, etc. Anyone else completing this form must include the complainant’s name, if known. Against Whom - If the complainant reveals the name of the alleged perpetrator, and you are not a member of the staff at Student Health Services, the Counseling Center, FSAP, or S.O.S., you must include that information here. You should maintain privacy of the alleged perpetrator’s name and not share it with anyone. If the complainant does not reveal the name of the alleged perpetrator, other types of information can be noted such as the individual’s affiliation to UD, if the perpetrator is a student at another school, a visitor, a vendor, etc. Description of the Incident – try to get as much information about the events that happened (as revealed by the complainant) such as the circumstances of the conduct, what conduct was disturbing and how, names of witnesses or others involved, etc. Refrain from judgment and describe the facts that were told to you or that you witnessed. Email the form to a Deputy Title IX Coordinator (as listed above) or to the University Title IX Coordinator, Susan Groff (information above).
Fillable-Title-IX-Reporting-Form-2jmu0k0.docx