Title IX Online Form | Legal Affairs | Chicago State University

Title IX Incident Report

If you see this don't fill out this input box.

Tell us what you are able to about the incident. If possible, please include a classification of the type of incident, such as sexual assault, dating or domestic violence, stalking, or harassment.

Please tell us what you are able to about the location of the incident, such as as address, on-campus, off-campus, private residence, public location, etc.

Please tell us what you are able to about the assailant. If name is unknown or you do not wish to disclose name, you can include information such as number of assailants, gender, and physical description. If applicable, you may also provide information on any current or previous relationship with the assailant. This section can be left blank if you are unsure of information about the assailant.

Is there any other information you want us to know?

You are not required to provide contact information but we would appreciate the chance to speak with you further. If requested, we will contact you as soon as possible during business hours.

Please check all that apply

I am including my contact information above and would like to be contacted by a confidential staff member by phone.I am including my contact information above and would like to be contacted by a confidential staff member by email.I am not the survivor/victim in the situation reported above but would like to be contacted by a confidential staff member by phone.I am not the survivor/victim in the situation reported above but would like to be contacted by a confidential staff member by email.I am including my contact information but do not wish to be contacted at this time.I am not including my contact information.

Please include your name if you wish.

Please include your phone number if you wish.

Please include your email if you wish.