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Sexual Misconduct Complaint Form


This form provides preliminary information to the Office of Equity and Inclusion to assist in resolving violations of 黑料网's Sexual Misconduct Policy. Please complete the form to the best of your knowledge. The information you provide will be kept confidential to the extent permitted by law. More information can be found on the Sexual Misconduct/Title IX web page here.

We recommend that you familiarize yourself with the policy and process.

Procedures are based upon the type and date of the report of the alleged misconduct.

If you have questions, please contact Victoria Deaton, Title IX Coordinator at 919-536-7250 ext. 6013 or at deatonv@durhamtech.edu.

If you need assistance in filling out this form, please contact Counseling and Accessibility Services. They are located on the Main Campus in Wynn Center (Bldg. 10), room 209
919-536-7200, ext. 1408
counseling@durhamtech.edu
Monday – Friday:
8 a.m. – 5 p.m.


To print or save your report to PDF, use your browser's Print command.

NOTE: If you wish to submit your complaint anonymously, you may omit Contact Information, print this form instead of submitting it online, and deliver or send it to:
Victoria Deaton
Title IX Coordinator
Office of Equity and Inclusion
Phillips 03-103C
1637 Lawson Street
Durham, NC 27703

Background Information

 
Email address must be of a valid format.
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Use your 黑料网 email address if you have one
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Enter all seven digits of your college ID# (Enter Full DL# or ID# if visitor)
This field is required.
This field is required.
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Involved Parties

Please provide the following information about the individual(s) you believe discriminated against you, harassed you, or retaliated against you. This may include incidents of sexual harassment, sexual violence, relationship violence, and stalking.

If the individual is a college visitor, please list a driver's license number in the block labeled "ID Number," if available.

If you have listed your information as the person submitting the report (reporting party), you do not need to re-enter your information here. If possible, include all seven digits of a 黑料网 ID in the "ID Number" field. Names should follow this format: FirstName LastName.

If you are completing this as a Responsible Employee, please indicate all involved parties that were shared with you and their respective roles.

For the purposes of this form and 黑料网's policies, the following definitions are used:

  • Complainant: the individual to whom the misconduct was directed;
  • Reporting Party: the individual who is reporting the misconduct;
  • Respondent: the individual who may have violated College policy;
  • Witness: the individual who observed the alleged behavior and can provide additional information
Involved party 1

Questions

Are you reporting this incident for yourself or for another person?(Required)
This field is required.
What is the nature of this report? (Please select all that apply.)(Required)
You must make at least one selection.
Do you feel this behavior happened because of: (Please select all that apply.)(Required)
You must make at least one selection.
Are you or are any of the roles (complainant, respondent, witnesses) a minor (under the age of 18)? If this is known, note this in your narrative. (For example: "I am a minor", or "the student it happened to is a minor").(Required)
This field is required.
This field is required.
Please identify if you are completing this form as a Responsible Employee or Designated Official. Responsible Employees and Designated Officials have the duty to report incidences of sex discrimination or any other misconduct to the Title IX Coordinator(Required)
This field is required.
By completing and submitting this form, I agree that I was provided a hyperlink to access to 黑料网's Title IX policies and their related procedures.(Required)
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