Sex Discrimination, Sexual Harassment, Sexual Misconduct or Interpersonal Violence (Title IX)

By submitting this report, you are stating that all information contained in the report is true and correct to the best of your knowledge. Knowingly filing a false record may lead to University Administrative Action. Please know that the University takes reports of this nature seriously, and prohibits retaliation for making a good faith report of misconduct.

Furthermore, please realize that the individuals involved may be afforded certain privacy rights under the Family Educational Rights and Privacy Act (FERPA) which established requirements regarding the privacy of student records. Please note that parties have the right to inspect any information submitted regarding this matter.

Similarly, employees may be afforded certain privacy rights in regards to personnel matters. Once this report is received, Title IX Personnel may contact you via phone or e-mail to discuss the matter in further detail.

As a reminder: all responsible individuals including staff members, faculty members, and administrators with the exception of those working in a confidential capacity (e.g., counselors, victim advocates, Ombuds officers, medical providers, and clergy), who learn of suspected incidents of Prohibited Conduct that involves any student as a complainant, respondent, and/or witness (directly or indirectly) have a duty to report all known information immediately to the Office of Institutional Equity/Title IX Coordinator through this reporting form.

Your full name:

Your position/title:

Your phone number:

Your email address (required):

Email address must be of a valid format.

Your physical address:

Reason for this report(Required):

This field is required.

Law Enforcement agency called(Required):

This field is required.

Date of incident(Required):

This field is required.

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Must be formatted YYYY-MM-DD

Time of incident:

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Please be sure to indicate AM or PM

Location of incident(Required):

This field is required.

Specific location :

Involved Parties

Please list any individuals involved excluding yourself. Please note that individuals involved in incidents of sex discrimination, sexual harassment, sexual assault, relationship violence or stalking are referred to as Complainants, Respondents and Witnesses.

* Any person who feels they have been subjected to Prohibited Conduct shall be referred to as "Complainant."

* Any individual or group who has been accused of committing an act of Prohibited Conduct shall be referred to as “Respondent.”

* Any person who has directly observed an incident or has direct or indirect knowledge related to an incident of Prohibited Conduct shall be referred to as “Witness.”

Involved party 1

Name of Individual or Organization

Select Gender

Select Role

UCF ID Number

DOB (YYYY-MM-DD)

Phone number

Email address

Hall/Address

Incident Reporting

Please complete the fields below

Please provide a detailed description of the incident/concern using specific concise, objective language. Please make sure to include all relevant information, including who was involved in the incident, how each person associated with this report was involved in the incident, what happened during the incident, where the incident took place and when the incident took place, and how you became aware of the incident.(Required) This field is required.

What other departments have been notified?(Required)

UCF Police Department

Other Law Enforcement

UCF Victim Services

Counseling & Psychological Services (CAPS)

Student Health Services

Off Campus Health Services

Residence Life

Student Care Services

Human Resources

Other (i.e. Department Chair, Dean, Supervisor)

None

You must make at least one selection.

If you answered "Other" above please specify what other department was notified. This field is required.

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.

Submission

Email me a copy of this report