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Title IX Complaint Form
Please provide as much detailed information as possible in the Title IX Complaint form below.

If you are having trouble submitting the form below you may download a printable version of the form and email it to titleixcoordinator@vhcc.edu.
Today's Date:

Information Regarding the Complainant:
Name of Complainant:
Complainant's Phone Number:
The Complainant is (please select one):
For faculty, staff & students, indicate whether:
Information Regarding the Alleged Victim (if he or she is not the Complainant):
Name of the alleged victim:
The alleged victim is (please check one):
For faculty, staff & students, indicate whether:
Information Regarding the Respondent:
Name of the Respondent:
Respondent’s phone number (if known):
The Respondent is (please check one):
For faculty, staff & students, indicate whether:
Information Regarding the Alleged Misconduct (sexual harassment, sexual violence, domestic violence, dating violence, or stalking):
Date of the alleged Misconduct:
Time of the alleged Misconduct:
Location of the alleged Misconduct:


Witnesses or third parties who may have information regarding the alleged Misconduct, along with phone number, if known:
NamePhone number (if known):
1
2
3
4
5
6
Please provide a brief description of the alleged Sexual Misconduct:
You may wish to consider including, among other things, some or all the following information in your description: the gender of the parties, the relationship between the parties, whether one or more of the parties were under the influence of alcohol or drugs at the time of the alleged Misconduct, whether the Respondent used pressure or force (physical or otherwise) in the course of the alleged Misconduct, and the frequency (if applicable) of the alleged Misconduct.

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