Title IX: Sex-Based Hazing Incident Reporting Form

This form should be used to report alleged acts of hazing that may violate Title IX Policy 14 and/or hazing laws. We ask that you provide as much detailed information as possible regarding the alleged incident. If you or anyone else you know is in need of immediate assistance, call (304) 766-3353 between 8:30AM and 5:00 PM or dial 911 in case of emergency after 5:00 PM. Do not use this form to report other violations of university policy, a student of concern, or Honor Code violations. For other violations of university policy, please make your report to the appropriate office (i.e., Title IX at: Title IX Reporting Form – West Virginia State University, Student Conduct or WVSUPD) using the specific incident report form for each office.

Background Information

Provide your name and contact information to report any known or any reports made to you regarding acts of hazing. If you choose to remain anonymous and to not provide your contact information, the name of the organization and any other specific details, the university may be limited in its ability to address the allegations.

Sex-Based Hazing Incident Reporting Form

This form should be used to report alleged acts of hazing that may violate Title IX Policy 14 and/or hazing laws.

Name

First Last

Phone

Country Phone Number

Name of the organization you are reporting:(Required)

Date of alleged incident: MM/DD/YYYY(Required)

Time of alleged incident:

Specific location of alleged incident:(Required)

Witness names, if any(Required)

Witness Contact information, if known(Required)

How did you become aware of the incident?(Required)

Detailed description of the alleged hazing behaviors using specific concise, objective language, specific instances, detailed examples, and as much contextual information as you have. Descriptions of hazing behaviors can be found within the Student Handbook at: Student Handbook – West Virginia State University (page 20).(Required)

Supporting Documentation The files can be uploaded below.

File

Max. file size: 98 MB.