Title IX Reporting Form

Background Information

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Your full name:

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the person reporting this matter; can leave blank if wishing to report anonymously

Your Position/title:

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(e.g., ENG Instructor; Admissions Officer; Student, . . . )

Your phone ext or cell number:

Your GTCC email address:

Email address must be of a valid format.

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can leave blank if wishing to report anonymously

Your office location:

Date of incident(Required):

This field is required.

Time of incident:

Location of incident(Required):

This field is required.

Specific location:

Information on Parties Involved in the Incident

Please list the individuals involved (excluding yourself), including as many of the listed fields as you can provide. Use the "Add Another" button below to list additional parties.

Name of Person

Perceived Gender

Select Role

ID Number

Incident Information

Provide a detailed description of the incident, include as much information as possible as you use objective language in documenting what occurred (Who, what, where, when, and how) rather than expressing your opinions. Other than "I", please limit your use of pronouns to avoid confusion on the part of the reader).(Required) This field is required.

Were Campus Police contacted?(Required)

Yes No

This field is required.

Does the party against whom the alleged violation occurred prefer to remain anonymous?(Required)

Yes No

This field is required.

Please check this box to signal your understanding that, if you have provided your contact information at the beginning of this form, your anonymity cannot be fully guaranteed. If you wish to remain anonymous you may leave your contact information off of this form, with the understanding that this will limit the scope of action that can be taken by the Title IX Office in response.(Required)

Yes, I understand

You must make at least one selection.

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Email me a copy of this report

Background Information

Information on Parties Involved in the Incident

Incident Information

Supporting Documentation

Submission