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Sexual Harassment/Misconduct Reporting Form


THIS FORM SHOULD NOT BE USED TO REPORT AN EMERGENCY OR IMMEDIATE THREAT TO SAFETY. IF YOU ARE EXPERIENCING AN EMERGENCY, CALL FVSU PUBLIC SAFETY AT 478-825-6211 OR THE LOCAL POLICE AT 9-1-1.


WE ARE HERE FOR YOU! Regardless of your current physical location or if the occurred on campus or not, the Title IX staff will receive the information reported below and respond to your concern.

If you are concerned about abuse while self-isolating, please visit the National Domestic Violence Hotline for safety planning and ways to reach out for assistance.

This form is used to report sexual or gender-based misconduct, including sexual harassment, sexual violence, stalking, or relationship violence to FVSU in accordance with FVSU's Title IX/Sexual Misconduct Policy. The information you provide is sent directly to FVSU's Title IX Coordinator for review and response by the next FVSU’s business/school day. The privacy of this information will be maintained to the greatest extent possible while allowing the university to respond appropriately to promote safety and accountability. Reports about employee misconduct are also reviewed by the Director of Human Resources.

If you have experienced sexual violence and you are not sure whether you are interested in reporting the incident, please consider utilizing a confidential resource such as Director of Counseling Services-478-825-6174/478-662-015 University Counselor-478-822-1033 or 229-401-8431 . If you would like to report this incident anonymously, just leave your name and any contact information blank. Please be aware that the IP address of the computer from where the report is submitted may be recorded. While FVSU takes all reports of sexual misconduct seriously, the ability to follow up with you is limited if you do not provide your contact information. Responsible employees reporting an incident are required to include their contact information.

If you have experienced a crime of sexual violence, please review your rights and options including support and assistance, confidential and non-confidential reporting, and the university's investigation and resolution procedures. The information you share below constitutes a report to the university. If what you experienced constitutes a crime, you may also want to consider reporting it to the local law enforcement agency with jurisdiction for the location where the incident occurred.

If you have any questions, you can email FVSU's Title IX Coordinator.

Fort Valley State University
Office of Legal and Government Affairs – Huntington Building
1005 State University Drive
Fort Valley, GA 31030
For more Information and related policies, resources and procedures.
Title IX Webpage: https://www.fvsu.edu/title-ix-sexual-misconduct/
Concerns: http://www.fvsu.edu/say-something/

Reporting Party Information

 
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Involved Parties

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Questions

Person who is reporting the incident (Check One)(Required)
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Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
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