Title IX (Sexual Harassment) Complaint Form

This form is used to submit a formal complaint of misconduct to the college. Sexual misconduct includes rape, sexual assault, sexual harassment, sexual exploitation, stalking, and dating and domestic violence. This form may be used by students or employees, or by any other person who experiences sexual misconduct on campus or in connection with a college program or activity. A formal complaint must be submitted before CLCC will begin an investigation of sexual misconduct. Once submitted, the Title IX Coordinator will inform all parties that a formal complaint has been filed, will explain their rights under college policies, and will open a formal investigation.

A formal complaint is not required to obtain supportive measures such as changes to class schedules or living accommodations, no contact orders, referral to counseling or advocacy, or excused absences. Supportive measures are available irrespective of whether a complaint is filed and may continue as needed regardless of the outcome of a formal investigation.

Reporting Persons Identifying Information

Name

First Name

Middle Name

Last Name

Address

City

State

Zip

Phone

CLCC ID

(if applicable)

Relationship to Co-Lin Relationship to Co-Lin

Description of Misconduct

Name(s) of the person(s) who committed sexual misconduct, if known:

Name(s) of the victim(s), if different than the person submitting this report:

Please describe what happened. When possible, please include specific names, dates, times, locations, witnesses and other pertinent information:

Do you have any contact information (cell phone number, email address, physical address, etc.) for the person or persons who committed the offense?

Yes

Please list any contact information here:

Are there any witnesses to what happened?

Yes

Please list names and any contact information you may know:

Are there any documents, recordings, photographs, emails, text messages that may contain information about what happened? Are there any physical objects, such as clothes or sheets, that might provide information?

Yes

Please describe them here:

It is important that you are aware of key provisions of the college's sexual misconduct policy. Please review the following and type your name under the statements to indicate that each statement is correct.

1. I have been provided with a copy of the college's sexual misconduct policy.

2. I understand that when I submit this complaint, the college will conduct a formal investigation of the reported conduct.

3. I understand that the information I provide the college in this report and any subsequent conversations or exchanges is considered private, but is not confidential. The college may be required to disclose certain information in order to adequately investigate.

4. I understand that the accused person(s) will be informed of this report, will be informed of their rights under CLCC policies, and will be informed that retaliation of any kind will not be tolerated.

5. I have been informed of my right to file a criminal complaint with a law enforcement agency.

6. I have been informed that the college offers supportive measures that include counseling, extensions of deadlines or other course-related adjustments, modifications of work or class schedules, providing an escort or other security, mutual orders mandating no contact between individuals, changes in housing or work locations, leaves of absence, monitoring of certain areas, or other similar measures, as the college deems appropriate. I understand that these are available irrespective of whether a formal complaint is filed.

7. I understand that I can seek supportive measures by communicating that request to the Title IX Coordinator.

8. I understand that I have the right to be accompanied to any meeting or hearing in this process by an advisor of my choosing, who may be but is not required to be an attorney. I understand that the college will appoint an advisor at no charge upon written request from me.

9. I understand that should I decide not to proceed with formal charges against the accused, the college will carefully consider that request. I also understand that, in some instances, the college may be required to proceed despite that request in the interest of safety.

Please type your name below to acknowledge you understand the above statements. This serves as your digital signature.

I certify that the information I have provided in this report is true and correct to the best of my knowledge. This serves as your digital signature.

If you are human, leave this field blank.

Title IX (Sexual Harassment) Complaint Form

Reporting Persons Identifying Information

Description of Misconduct

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