Title IX Report Form

Title IX Report Form


Items marked with a red * are essential information for our investigation. Please give us as much information as you can.

Contact Information





Would You Prefer To Be Contacted? *

If you prefer to be contacted you must enter your e-mail address and/or phone number below
Background Information
*
Involved Parties
Please list yourself as well as any other individual who may have information regarding the incident.
Involved Party 1
+ Add Another Involved Party
Additional Questions
*
*
*
*
*
Supporting Documentation
Photos, video, email, text, campus safety report, and other supporting documents may be attached below. Attachments require time to upload, so please be patient after you click to submit this report.
+ Add Another Document
Resources
Additional Resources
 
(315) 792-3006
1600 Burrstone Road | Utica, NY 13502