Pennsylvania College of Art & DesignTitle IX Complaint Form

Title IX Complaint Form

If you have experienced or witnessed sexual misconduct or sex discrimination, the College wants to know so we can take appropriate action.

Your Information
Full Name
Phone
Email
Offender
Offender Name(s)*
Name of person or persons you believe committed the offense against you and how you have contact with them, e.g. teacher, faculty, student.
About The Incident
Type of Incident*
- Bullying
- Cyberbullying
- Gender Descrimination
- Gender Inequity
- Sexual Harrassment
- Sexual Assault
- Stalking
- Rape
- Retaliation
- Relationship Violence
Date of Incident*
MM slash DD slash YYYY
Location of Incident*
Describe the Incident in Detail*
Other Parties Notified
Have you brought this matter to any other department(s) at the College? If so, please list the name(s) and department(s) of those persons.
Witnesses
Witness Name(s)
Name of person or persons who witnessed the incident against you and their relationship to you, e.g. teacher, faculty, student, family, etc. Also, include how they can be contacted by our Title IX Coordinator.
Confirmation
Do you certify that the above complaint is true and correct?*
Yes

Title IX Complaint Form