Incident Reporting First Name Please provide a first name Last Name Please provide a last name Role in the incident Choose one... Victim Witness Offender Please select a role Email/Phone LUID Please provide LU ID as a number only Employees are required to report all known information. Please provide detailed information regarding the incident you are reporting. First Name* Please provide your first name Last Name* Please provide your last name LU ID* Please provide your LU ID as a number only My Status Staff Faculty Student Other Contact Information* (Enter your Email or Phone Number) Please provide your contact information Address* Please provide your address Position/Title* (If Applicable) Please provide your position/title Department Name* (If Applicable) Please provide your department name Persons Involved You must provide information for at least one person involved. First Name* Please provide a first name Last Name* Please provide a last name Role in the incident* Choose one... Victim Witness Offender Please select a role Email/Phone LUID Please provide LU ID as a number only Nature of the Report* (Check all that apply) Discrimination False Reporting Harassment (Non-Sexual) Intimate Partner Violence Intimidation Retaliation Sexual Exploitation Sexual Harassment Sexual Violence Stalking Please select the nature of the report Date of Incident* formatted as MM/DD/YYYY Please provide the date of the incident Time of Incident* Please provide the time of the incident Location of Incident* Please provide the location of the incident Have you notified anyone else about this incident?* No Yes Please select the notified indicator Provide as much detail as you are comfortable with. An appropriate staff member at Title IX Office will review.* Please provide some detail of the incident Submit