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Report Sexual Harassment

Please submit the completed version of this electronic form, or download and complete the PDF version of this form and submit it to:

Emily Scott
Title IX Coordinator
Greensboro College
Main Building, Room 231
Greensboro, NC 27401

This form may also be submitted by email to titleix@greensboro.edu. Please contact Emily Scott at 336-272-7102, ext. 5496, or the email above with any questions.

Messages regarding incidents of potential sexual harassment may also be left at 336-217-7259. The college’s ability to respond or take further action may be impacted by what information is available about the incident or the individuals involved.

Complainant's Information

Complainant's Name(Required)

First Last

Complainant's Affiliation (student, faculty, staff, unaffiliated)(Required)

Complainant's Phone(Required)

Complainant's Email

Complainant's Preference for Action

No Action

Formal Complaint

Voluntary Resolution

Respondent's Information

The individual accused of committing the misconduct

Respondent's Name

Leave blank if not known

First Last

Respondent's Affiliation (student, faculty, staff, unaffiliated)(Required)

Respondent's Phone

Respondent's Email

Incident Information

Incident Date(Required)

Incident Time(Required)

Location or Address of Incident(Required)

Description of the Incident

Nature of harassment; context or circumstances, such as on-campus event, off-campus party, travel, etc.

Reporter's Information

If different from complainant

Reporter's Name

First Last

Report Date(Required)

Reporter's Phone

Reporter's Email

Additional Information

Additional Details

Provide any additional details here that could be helpful (other witnesses, preference for privacy, conditions to improve on campus, interim measures requested, etc.)

Comments

This field is for validation purposes and should be left unchanged.