TITLE IX Sexual Discrimination Sexual Misconduct Reporting Form
Policy of Non-discrimination: Harris-Stowe State University and Title IX law prohibit discrimination on the basis of sex in its education programs, activities, admissions, recruitment, financial aid, academic programs, student services, athletics, housing and employment. Title IX law and the University prohibit exclusion from or being denied the benefits of any academic, extracurricular, occupational training, sports, research, or other education program and activity on the basis of gender and/or sexual orientation.

HSSU Campus Security Phone Numbers: 314-340-3333, 314-280-9971, and 314-340-5952. For Local Law Enforcement Dial 911

 

Identity of the person filling out this form (leave blank if reporting anonymously)

Identity of the individual who experienced the sexual assault or other form of sexual misconduct (leave blank if reporting anonymously)

Date of incident(s). If unknown, provide information about approximate timeframes (mm/dd/yyyy)

Time of incident(s) if unknown, provide information about approximate timeframes (hh:mm a.m./p.m.)

* Location of Assault/Incident







Please provide any other information regarding the location of the incident(s)

* Nature of the incident (check all that apply)
















Please describe whatever other information you are willing to provide regarding the incidents(s)

Identity of the individual who committed the sexual assault or other form of sexual misconduct. Please put full name, phone number and email if known.

* To your knowledge was this incident reported to a local law enforcement agency?



If you have notified anyone else about this incident please list them below.

Affiliation of the person who committed the sexual assault or misconduct with the individual who experienced sexual assault or misconduct (check all that apply)















Are there any additional details concerning the incident that you believe we should know

* Please type the letters in the image in the area below (must be in the correct order).

[Data we collected on this form also includes a user ID of HSSU_Constituent, a data entry ID of UNKNOWN a context of TIX_Reporting_Form, a session id of 7BCA–6459448D-F529-F8CC-B0A4B9737A08604B and an IP address of 54.145.82.104]. 2024-03-29 06:47:10. This form has been completed 16 times.