Silent Witness and Title IX Reporting Form

Please complete the form below. Required fields marked with an asterisk *

Please note: In order for the incident to be fully and properly investigated, please provide as many specific details as possible.

Reporting Sexual Harassment

Any person may make a report of sexual harassment regardless of whether the person reporting is the person alleged to be the victim of the reported conduct or not.

Reports may be made in person, by mail, telephone, this online submission form, or email using the contact information provided for the Title IX Coordinator.
Reports can be made at any time, including non-business hours.

Title IX Information

Location of Incident or Crime

Answer required for "Location of Incident or Crime"

Date of Incident

Answer required for "Date of Incident"

Time of Incident

Answer required for "Time of Incident"

Description of Incident

Answer required for "Description of Incident"

If applicable, describe any relevant communication that has already occurred to address this issue. Please be specific with any dates and names of individuals with whom any communication has occurred.

Answer required for "If applicable, describe any relevant communication that has already occurred to address this issue. Please be specific with any dates and names of individuals with whom any communication has occurred. "

Any other relevant info:

Answer required for "Any other relevant info:"

Suspect Name (if known)

Answer required for "Suspect Name (if known)"

Sex

Answer required for "Sex"

Male

Female

Unknown

Age and/or Grade of Suspect

Answer required for "Age and/or Grade of Suspect"

Approximate Height

Answer required for "Approximate Height"

Approximate Weight

Answer required for "Approximate Weight"

Race

Answer required for "Race"

Hair Color

Answer required for "Hair Color"

Eye Color

Answer required for "Eye Color"

Other identifying characteristics (clothing, tattoos, piercings, facial hair, etc.)

Answer required for "Other identifying characteristics (clothing, tattoos, piercings, facial hair, etc.)"

Vehicle Information (if applicable)

Answer required for "Vehicle Information (if applicable)"

Your Name (if you choose to provide)

Answer required for "Your Name (if you choose to provide)"

I am

Answer required for "I am"

Student

Parent

Telesis Staff Member

Other:

Phone (Optional)

Number Required

Email (Optional)

Answer required for "Email (Optional)"

Please fix the highlighted areas below before submitting.

Silent Witness and Title IX Reporting Form

Reporting Sexual Harassment