Title IX Incident Report Form

  1. Glenville State University
  2. About Us
  3. Emergency Information
  4. Title IX / Sexual Misconduct
  5. Title IX Incident Report Form

This form is for filing report incidents of discrimination, sexual violence (harassment, assault, misconduct), sex/gender discrimination, and harassment that you believe are in violation of Glenville State University’s policy. This form is to prevent, protect, assess any possible Title IX issues and incidents. When filling out this form understand this does not constitute as filing a Formal Complaint. This report is to reach out to the affected party to ensure safety, give supportive measures, and explain further options.

If this is emergency please call 911.

If you feel unsafe please call Public Safety at 304-904-2041.

Who can fill this out

Anyone can report on someone else’s behalf or for themselves. All faculty, staff, graduate students, are considered mandatory reporters and are encouraged to report. Those who are not mandatory reporters are counselors and H.O.P.E. advocate.

Is this confidential?

No, this is not a confidential form. It will be sent to the Title IX Coordinator so they can reach out to affected party.

Title IX Brochure

Incident Information

 

Your Information

(This information is not required if you wish to remain anonymous)

 

Information of Person Being Harmed, if Different

 

Additional Information

Anonymously Disclaimer

You can fill this out anonymously, but the University may be limited in following up and/or have limitations in gaining sufficient information. Information and possibilities on following up and action will be limited.

This is not supposed to discourage you from reporting it is telling you that it will be looked into, but further information will possibly be needed.