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Sexual Misconduct, Intimate Partner Violence, Stalking Reporting Form

Purpose

This form should be used to report allegations of sexual misconduct to the University of North Texas System Title IX Coordinator. Reportable offenses include allegations of sexual harassment, sexual assault, dating violence, domestic violence, stalking, sexual coercion, and sexual exploitation as defined by state and federal law, and/or University System policy.

Please know that anonymous reports may impair, limit, or delay the UNT System's ability to take appropriate action on the report.

Sexual misconduct is prohibited by the following UNT System policies:

03.705 Prohibition of Sexual Assault and Retaliation

03.901 Prohibition Against Discrimination, Harassment, Sexual Misconduct and Related Retaliation (Including Sexual Assault, Sexual Violence, and Stalking)

This form should be used when the person (or persons) involved in the alleged misconduct is a member of the UNT System (UNTS).

PLEASE BE AWARE: Completing this report does not consitute a police report. If you need IMMEDIATE ASSISTANCE call 911. This form generates a report that is normally reviewed during business hours and does not take the place of law enforcement assistance.

If you would like resources for support you can contact any of the following:

Denton County Friends of the Family - 940-387-5131; or 24-hours Crisis line 940-382-7273

Collin County Community Resources, Turning Point - Crisis Line 800- 886-7273

The Women's Center of Tarrant County - 817-927-4040

One Safe Place of Fort Worth 817-916-4323

Dallas Area Rape Crisis Center - 972-641-7273

Genesis Shelter of Dallas 214-946-4357 (call or text)

UNT Employee Assistance Program - 800-343-3822

Hospitals and Law Enforcement Agencies

· Baylor Hospital (Fort Worth): 817-926-2544

· Harris Methodist Hospital (Fort Worth): 817-250-2000

· John Peter Smith Hospital (Fort Worth): 817-702-2839

· Fort Worth Police Department (non-emergency): 817-335-4222

· Methodist Hospital (Dallas): 214-947-8181

· Parkland Hospital (Dallas): 214-590-8000

· Dallas Police Department (non-emergency): 214-744-4444

· Denton Police Department (non-emergency): 940-349-8181

· Frisco Police Department (non-emergency): 972-292-5010

If you need assistance completing this form or an alternate format, please contact Title IX Coordinator, Dr. Maureen McGuinness at Maureen.McGuinness@untsystem.edu or 817-735-5919.

Background Information

Please fill out the following information to the best of your knowledge.

Definition of Roles

Complainant: The individual who experienced the alleged behavior

Respondent: The individual who engaged in the alleged behavior

Witness: An individual who has a first-hand account of the alleged behavior

Bystander: An individual who has a first-hand account of the alleged behavior and who tried to intervene to stop the alleged behavior

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Your full name:

Your position/title:

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Title or Role (Student, Employee, Third Party)

Your phone number:

Your email address:

Email address must be of a valid format.

Respondent's relation to UNTS(Required):

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Urgency of this report(Required):

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Date of incident(Required):

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mm/dd/yyy

Time of incident:

Location of incident(Required):

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Involved Parties

To the best of your ability, please list any party that may be invovled.

First and Last Name

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Phone number

Email address

Report Information:

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
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Background Information

Involved Parties

Report Information:

Supporting Documentation

Submission