Kent State University


Office of Gender Equity and Title IX


Title IX Report or Complaint Form
Gender & Sex Discrimination/Sexual Harassment

To report events presenting an immediate threat to health or safety, please dial 911.


This form does not constitute filing a criminal complaint with the police. To file an official police report, please contact KSU Police Services at 330-672-2212.


Sexual harassment may be reported to the Title IX Coordinator using this form. Sexual harassment includes sexual assault, dating violence, domestic violence, and stalking consistent with Administrative policy regarding complaints of Title IX sexual harassment.



How to use this form?

  • File a report: A report is submitted by a responsible employee, student, guest, or visitor who receives notice of a Title IX incident or situation.

  • To file a formal complaint: A complainant/victim may request an investigation into allegations involving sexual harassment using this form.


Campus Support Services and Resources:


Submitting a report or complaint notifies the following:

  • Richantae Johnson, Director & Title IX Coordinator
  • Pamela Fitzgerald, Director, EOAA and Deputy Title IX Coordinator
  • Veronica Tomasko, Title IX Administrative Coordinator

Question: What happens when I submit this form?


The information will be reviewed by the Title IX Coordinator to first assess whether there are any potential safety concerns for the individual(s) involved or the University that need to be addressed in a timely manner. If possible, the Complainant will be notified about these actions.


Question: Will I be contacted?


After a report is assessed for safety concerns, the Office of Gender Equity & Title IX will reach out to the Complainant by email (or other contact information provided if provided) to acknowledge and follow-up on the report, provide options for support and resources, and share information regarding options and next steps.  See the Title IX Website for more information about the process.


Fields marked with an asterisk (*) must be completed for the form to be submitted.

REPORTING PARTY INFORMATION

(Reporter – individual, mandatory reporter, responsible employee, etc. who learns of alleged prohibited conduct but is not involved in the incident. If victim is filing the report, leave blank.)


First and Last Name
You may report ANONYMOUSLY by omitting information in any field. Please note anonymous reports may be difficult to investigate.


Please include Staff/Faculty department/college name, Campus location, Building Name and/or Mailing Address, Phone number, and Email

VICTIM/COMPLAINANT INFORMATION

(Complainant – individual who is the alleged victim)






(Select "Off Campus" if the incident did not occur on a Kent State campus)








(phone, email address, etc.)










NOTE:

The University will keep all information pertaining to the investigation as confidential as possible. After filing a formal complaint with the university, the complainant’s name and any written statements submitted may be disclosed to the accused. Relevant information disclosed during the investigative process may be shared with the accused (and the student conduct hearing panel or as part of an investigative summary, when applicable) in order to properly investigate and adjudicate the complaint.



I have read and understand this document. I affirm my responses are accurate to the best of my knowledge and this form has been completed in good faith.