Title IX Reporting Form
This form is intended to report incidents of discrimination on the basis of sex, sexual assault, sexual harassment, interpersonal violence, stalking, sex discrimination, sexual exploitation, and unprofessional or inappropriate conduct. Anonymous reports may limit Kiamichi Tech's ability to respond to the allegations. If reporting anonymously, please leave the name and contact information fields blank and indicate your report is anonymous below.
Submission Contact Information
Students, employees, parents/guardians or members of the public can file a report. As the individual submitting the complaint, please include your contact information here.
I am completing this complaint as a:
*
Please Select
Student
Parent
Employee
Anonymous
Name of Individual Submitting Complaint
First Name
Last Name
Email of Individual Submitting Complaint
example@example.com
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Complainant Contact Information
Individual who is alleged to be the victim of conduct that could constitute discrimination, harassment or retaliation. Anonymous reports may limit Kiamichi Tech's ability to respond to the allegations. If reporting anonymously, please leave the name and contact information fields blank.
Campus:
*
Please Select
Antlers
Atoka
Durant
Hugo
Idabel
McAlester
Poteau
Spiro
Stigler
Talihina
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
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Respondent Information
Person or persons you believe committed the alleged offense against you and how you have contact with them (e.g. peer, teacher, co-worker, supervisor, etc.)
Name
*
First Name
Last Name
Relationship to Complainant (alleged victim):
*
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Type of Complaint
Sexual Harassment
Sexual Assault
Gender-Based Harassment
Dating Violence
Stalking
Retaliation
Cyber Bullying
Other
Complaint
Please describe the behavior, comments or incidents that caused you to file your complaint.
Include as much detail as possible, including the date(s), time(s), location(s), etc. Please also identify witnesses to the incident(s) or those who have direct knowledge of the incident(s).
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If you have additional documents (i.e., email correspondence, police reports, text messages, videos/photographs) or evidence, please upload those documents here.
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of
Attestation
*
I attest that the information provided above is correct and accurate.
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