Anonymous Sexual Misconduct Report Form

Title IX and Sexual Misconduct Anonymous Report Form
The purpose of this form is to submit an anonymous report of a potential Title IX and Sexual Misconduct related violation you have witnessed or for which you have knowledge or have personally experienced. Please note that anonymous reports will be reviewed by the Title IX Coordinator. Based on the information provided, a determination will be made whether or not to conduct an investigation. Anonymous reporting does limit the College's ability to thoroughly respond to reports of a Title IX related situation. If there is an imminent threat to anyone's personal safety or if there is an emergency in progress, please contact Campus Police ( or local emergency services at 911. When making a report, please provide a detailed description of the Title IX related violation, using language as specific, concise, and objective as possible.

Please include the following:

Your affiliation with PRCC (Student, Faculty, Staff, Visitor or Guest)

Did you personally witness the situation or behavior?

Please list the individual(s) name(s) involved in the potential Title IX violation (or description of individuals if name is unknown)

Describe the situation below as clearly and with as much detail as possible: (If possible, please include: Date and time, location and other witnesses)

Each community college president is asked to bring two (2) wrapped door prizes, minimum value of $50 each. We will have a station set up at the conference for you to drop off the door prizes.

Each community college is asked to provide name tags for their Board members, administration, and staff attending the conference.