This form is to report alleged acts of sex- and gender-based discrimination and harassment.

Report/Referral Form

Sexual Discrimination, Sexual Harassment and Related Interpersonal Violence (Title IX)

This form is to report alleged acts of sex- and gender-based discrimination and harassment including hostile environment, quid pro quo, non-consensual sexual intercourse/contact, sexual exploitation, intimate partner violence, stalking or retaliation. If you have questions about where to direct concerns for other conduct concerns, please contact Shannon Walls.

Please fill out the information requested below to the best of your ability. All information provided will be handled with the utmost privacy.

All reports of sex- and gender-based discrimination and harassment made to Stephens College are taken with the utmost seriousness. Stephens College strongly encourages all members of the College community to report complaints of sexual offenses. Reporters do not have to be the victim/survivor of the alleged offense in order to file a report. In most cases, College employees are required to disclose reports made to them of sexual offenses.

You can make a report without any further participation in any investigation. You do not have to participate in an investigation or press charges to receive medical care, academic and other support. Retaliation against any person for making a report or participating in an investigation is strictly prohibited.

If you feel that your safety or the safety of the Claimant is at risk, please dial 911 or contact Campus Safety and Security at (573) 876-7299 or Ext. 4299.

* = required field

Reporter's Primary Phone Number *
Reporter's Alternative Phone Number
Date of Incident

Involved Party #1

Please list the individuals involved with as much information as you can provide.

Phone Number

Involved Party #2

Phone Number

Incident Narrative

Has the Claimant/individual who experienced violence, harassment or discrimination requested confidentiality? (i.e. that no College investigation be conducted or that no disciplinary action be taken)

One Last Step

I assert that the information I have included above is accurate to the best of my knowledge. *

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