The purpose of this form is to provide information to the Title IX Coordinator regarding concerns of sex-based discrimination, sexual harassment or sexual violence so that any further misconduct can be prevented, supportive measures can be provided as needed, and additional action, in accordance with Title IX Resolution Procedures, can be taken. If you have experienced any form of sexual violence, harassment or discrimination, the most important things are getting to a safe place and taking care of yourself. Realize that what happened to you is not your fault and that you are in control of what happens next. Telling someone is a brave act, but there may be reasons why you might not feel comfortable sharing with other people. At the same time there are many benefits to telling someone what happened and for this reason we encourage you to inform us on any incident. You can use this form to report an incident or you may contact the Title IX Coordinator, Natalie, Holick, at 913 588-8011 or

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