Sexual Misconduct | Incident Report Form

CBU is committed to providing a living, learning, and working environment free from discrimination on the basis of sex, in compliance with Title IX of the Education Amendments of 1972, and the Violence Against Women Reauthorization Act of 2013. Sexual misconduct is an umbrella term and includes discrimination or harassment based on sex, sexual assault, stalking, dating violence, and domestic violence, is prohibited.

This reporting form is for non-emergency incidents only. If this is an emergency, Call 911 or contact CBU Campus Police & Safety at (901) 321-3550.

CBU encourages individuals to report potential sexual misconduct. CBU takes reports made through this form seriously. Following the submission of the form, the reporting party can expect an outreach of support from the Title IX Office.

Individuals are encouraged to seek confidential medical, counseling, spiritual, and advocacy services. A list of on and off-campus providers can be obtained online at: https://www.cbu.edu/about/cbu-policies/sexual-assault-policy/reporting-obligations/

If you have questions, or you need accommodation for a disability or language assistance in order to fully
and meaningfully participate in this process or report concerns, email titleix@cbu.edu
or call (901) 321-3531.

Reporter's Name Reporter's Name First Last
While the form asks for your name, you can
elect to make this an anonymous report by omitting your name and contact
information.
Email address
Phone Phone - ### - ### ####
Type of Complaint *
Date of Incident Date of Incident * / MM / DD YYYY
Time of Incident Time of Incident : HH MM AM/PM
Location of Incident *
Specific Location (On Campus, Off-Campus, if known)
Please include a description of the incident, including details (Who, what, where, when, why, and how) *
Provide the name and contact information of the impacted or harmed individual. Individuals may report anonymously; however, the University's ability to respond to the allegations will be limited or impossible.
Provide the name and contact information of the individual alleged to have caused harm and identify any potential witnesses. *
Describe how you would like the complaint to be resolved. *
Supportive Measures: Individuals may have the right to reasonably appropriate measures to restore or preserve access to the living, learning, and working environment. For example, individuals may need academic extensions or adjustments to their class assignment or working environment or obtain a no-contact order (prohibiting communication between parties). The measures provided will be confidentially maintained to the extent that maintaining such confidentiality will not impair the University's ability to provide the accommodations. *

Supportive Measures: Individuals may have the right to reasonably appropriate measures to restore or preserve access to the living, learning, and working environment. For example, individuals may need academic extensions or adjustments to their class assignment or working environment or obtain a no-contact order (prohibiting communication between parties). The measures provided will be confidentially maintained to the extent that maintaining such confidentiality will not impair the University's ability to provide the accommodations. I acknowledge that I have been informed of the right to reasonably appropriate supportive measures.
ANTI-RETALIATION:The University encourages individuals to report sexual misconduct, or to participate in the grievance process. Retaliation can take many forms, including abuse or violence, threats, and intimidation. Individuals who feel they have been retaliated against should email titleix@cbu.edu. Individuals or groups who have been found to have engaged in retaliation and will be held accountable under this policy. *

ANTI-RETALIATION:The University encourages individuals to report sexual misconduct, or to participate in the grievance process. Retaliation can take many forms, including abuse or violence, threats, and intimidation. Individuals who feel they have been retaliated against should email titleix@cbu.edu. Individuals or groups who have been found to have engaged in retaliation and will be held accountable under this policy. I acknowledge that I have been informed of the prohibition on retaliation.
CONFIDENTIALITY & RIGHT TO AN ADVISOR: This complaint will be handled as privately as possible. Information is shared only on a need-to-know basis to be able to respond to concerns. Individuals have a right to an advisor of their choice who can provide support. The role of the advisor is limited to observing and consulting with you. *

CONFIDENTIALITY & RIGHT TO AN ADVISOR: This complaint will be handled as privately as possible. Information is shared only on a need-to-know basis to be able to respond to concerns. Individuals have a right to an advisor of their choice who can provide support. The role of the advisor is limited to observing and consulting with you. I acknowledge that I have been informed on my right to privacy and to an advisor.
DISCIPLINARY AMNESTY: The University maintains a policy of amnesty for students who offer help to others in need. Individuals or groups who have been harmed or witnessed misconduct while under the influence of alcohol or drugs are incentivized to share what they know. The University will generally not pursue disciplinary violations against a student or witness for their improper use of alcohol or drugs (e.g., underage drinking), if they are making a report of sexual misconduct. *

DISCIPLINARY AMNESTY: The University maintains a policy of amnesty for students who offer help to others in need. Individuals or groups who have been harmed or witnessed misconduct while under the influence of alcohol or drugs are incentivized to share what they know. The University will generally not pursue disciplinary violations against a student or witness for their improper use of alcohol or drugs (e.g., underage drinking), if they are making a report of sexual misconduct. I acknowledge that I have been informed of the potential for amnesty.
Attach Photos, video, email, and other supporting documents here. Or, email attachments to titleix@cbu.edu

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