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Title IX Reporting Form


Office of Equal Opportunity and Title IX

PLEASE REVIEW THE INFORMATION BELOW BEFORE SUBMITTING A REPORT.

If you are an individual with a disability for which you require alternative means or format to submit this report, please contact 512-245-2539 or TitleIX@txstate.edu. Someone will contact you to assist.

If you are a 'Responsible Employee', as defined in the policy, you are required to report ALL information received regarding the TSUS Sexual Misconduct Policy promptly (Section 4.4).

Within this referral form, you can file a report for any of the following categories of sexual misconduct:

Sexual Assault
Sexual Harassment
Dating Violence
Domestic Violence
Stalking
Sexual Exploitation
Sexual Intimidation (Cyber-stalking, Indecent Exposure, etc.)

 

NOTE:
If an assault has just occurred:
-Immediately find a safe place and if you are in immediate danger, call 911.
-Take care of yourself and get medical attention if necessary.
-Though you may not be able to observe any physical injuries, it is important to determine the risks of sexually-transmitted infections and pregnancy. To preserve the forensic evidence, ask the hospital to conduct a "S.A.N.E" exam.
-If you suspect you have been drugged, ask that a urine sample be collected (this is not part of the standard exam) so the sample may be analyzed by a forensic lab.

You can file a report for:

  1. Someone else.
  2. You can file a report anonymously (this does not apply to Responsible Employees).
  3. You can file a report using a pseudonym (this does not apply to Responsible Employees).


Please understand, that anonymous reports limit the university's ability to investigate since we have no way of contacting Complainants to obtain additional information or to get names of potential witnesses. This is especially true of allegations that would violate the TSUS Sexual Misconduct policy. Sharing your identity may be helpful to connect you with resources, like medical and counseling services, and provide information about your options for further action.

Reporter Background Information

University employees, also known as Responsible Employees, reporting on behalf of another party CANNOT maintain anonymity or confidentiality nor use pseudonyms within their reporting obligations.

IF YOU ARE EMPLOYED BY THE UNIVERSITY, YOU MUST RELAY ALL INFORMATION RECEIVED (INCLUDING NAMES, LOCATION, INCIDENT, INDIVIDUALS INVOLVED, ETC.) TSUS Sexual Misconduct Policy, Section 4.4.

 
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Please list your status (i.e. student, faculty, staff, visitor, student employee, unaffliated)
Email address must be of a valid format.
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Please utilize Texas State email (net ID). Personal email if not affliated with university.
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If unknown, please put today's date and detail in narrative. Also detail multiple dates in narrative
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If unknown, please place unknown. If multiple times, please explain in narrative
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This is the location where the incident occurred, not where information was received
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e.g., building on campus or off campus, street name, room number, kitchen area, common area, etc.

Involved Parties

1. IF YOU ARE SELF-REPORTING, PLEASE INCLUDE YOUR NAME BELOW AS THE COMPLAINANT.
2. Please list all individuals involved, completing as many of the listed fields as you can provide. Please note that all individuals involved, whether or not they are affliated with Texas State, should be included below. If you were not directly involved in the incident (witness, complainant or respondent), DO NOT place your name in the below section.
3. University employees ARE REQUIRED to provide all of the information available to them at the time of the report. This includes the name of the individuals and all personal information known (phone number, TXST ID, net ID, etc.).
4. Complainants who wish to remain anonymous do not have to provide their information, however, it may limit our ability to investigate the allegations presented.

Involved party 1

Incident Description

Please read all questions carefully and complete the information below to the best of your ability or knowledge. 

This field is required.
If law enforcement was involved, please select the agency that responded. (Check all that apply)(Required)
You must make at least one selection.
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Was anyone arrested by law enforcement?(Required)
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Does the Complainant want police intervention?(Required)
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Did emergency medical personnel respond?(Required)
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Was anyone transported to a hospital?(Required)
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How is the alleged perpetrator affiliated with Texas State University?(Required)
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How did you receive this information?(Required)
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Is the TIME of incident specific or approximate?(Required)
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Were any of the following involved? (Please see the policy regarding immunity from disciplinary sanctions)(Required)
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What is the racial/ethnic identity of the complainant? (victim/survivor)(Required)
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What is the racial/ethnic identity of the respondent? (perpetrator/accused party)(Required)
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REMINDER: A "RESPONSIBLE EMPLOYEE" MUST REPORT ALL RELEVANT DETAILS KNOWN TO THE EMPLOYEE ABOUT THE ALLEGED SEXUAL MISCONDUCT SHARED BY THE COMPLAINANT OR REPORTING PARTY (TSUS SEXUAL MISCONDUCT POLICY, SECTION 4.4). A RESPONSIBLE EMPLOYEE IS ANY INDIVIDUAL (FACULTY, STAFF, STUDENT EMPLOYEE) WHO WORKS FOR THE UNIVERSITY AND IS A MANDATORY REPORTER REGARDING INCIDENTS RELATED TO THE SEXUAL MISCONDUCT POLICY. FAILURE TO REPORT SO IS A VIOLATION OF THE SEXUAL MISCONDUCT POLICY AND SHALL RESULT IN TERMINATION OR OTHER DISCIPLINARY ACTION. PLEASE REVIEW THE ABOVE INFORMATION TO CONFIRM ACCURACY AND THAT ALL INFORMATION RELAYED TO YOU HAS BEEN REPORTED.(Required)
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Does the Complainant want to information to remain confidential? (Responsible Employees, i.e. mandatory reporters, please note if Complainant makes a request to remain anonymous or keep information confidential, you are still required to report all information, including all names of individuals and incident information).(Required)
This field is required.

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. PLEASE NOTE THAT COPIES OF EMAILS AND RESPONSES AS WELL AS ANY OTHER DOCUMENTATION SENT IS REQUIRED TO BE SUBMITTED FOR RESPONSIBLE EMPLOYEES. Please place all individuals involved (no matter if they are/are not affiliated with the university) within the "Involved Parties" section. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

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