Title IX Report

If you are unsure or would like to speak to someone about completing this report form, please contact Title IX Coordinator, Robert Taylor, robert.taylor@dordt.edu.

File a Report

Background Information

Your full name

Your email address

Nature of this report (required)

Urgency of this report (required)

Date of incident (required)

Location of incident

Involved Parties

Please include the following: name and role of the Complainant, the name and role of the Respondent, (if known), and the names and roles of any witnesses or bystanders who may have witnessed the behavior. If you do not know the name of the Respondent, please type, Unknown Respondent in the name field.

Definition of Roles:

Complainant: The individual who experienced the alleged behavior.
Respondent: The individual who engaged in the alleged behavior.
Witness: An individual who has a first-hand account of the alleged behavior.
ByStander: An individual who has a first-hand account of the alleged behavior and who tried to intervene to stop the alleged behavior.

Please List Name and Role of All Involved Parties

Example: John Doe - ByStander

Questions

Please provide brief answers to the best of your recollection.

Please provide a brief description of the incident:

Are you the Complainant or Witness?

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.

Choose files to upload

Drag and drop files here or click to upload

Title IX Process

For more information, please review our Title IX information in the Student Handbook.

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