myLWC: Title IX Complaint Form

Lindsey Wilson College

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Title IX Complaint Form

PURPOSE: The purpose of the Title IX Complaint Form is to inform Lindsey Wilson College of allegations of sexual harassment, sexual violence, and sex discrimination in violation of Title IX of the Education Amendments of 1972 ("Title IX") so that Lindsey Wilson College may take appropriate action.

All complaints will be reviewed to determine if the allegations meet the definition of sexual harassment under Title IX. Complaints that do not meet standards set forth by Title IX may be referred for consideration under the Lindsey Wilson College Student Code of Conduct, Employee Grievance Procedure, or other processes/procedures as deemed appropriate by Lindsey Wilson College.

Title IX defines sexual harassment to include any of three types of misconduct on the basis of sex, all of which jeopardize the equal access to education that Title IX is designed to protect:

Any instance of quid pro quo harassment by a school's employee;
Any unwelcome conduct that a reasonable person would find so severe, pervasive, and objectively offensive that it denies a person equal educational access;
Any instance of sexual assault (as defined in the Clery Act), dating violence, domestic violence, or stalking as defined in the Violence Against Women Act (VAWA).

If there is an immediate risk, please contact Public Safety and Security at 270-384-8106 or local police at 911.

Please fill out as much information as possible based on your knowledge of the incident. Required fields are marked with *

Please select the option that best describes you: (hover over an option for definition)*

Victim/Survivor

Respondent

Witness

Personal Information

LWC ID L#:

Full First Name:*

First Name:*

Last Name:*

Middle Initial:*

Email:*

Phone:*

Home Address:*

City:*

State:*

Zip:*

Gender:*

Male

Female

Other:

College Affiliation:*

Student

Staff

Other:

Classification:

Relation to Victim:

Incident Informaton

Nature of the Report: (select all that apply)
Click on each option to see its definition

Discrimination

Harassment

Relationship Violence

Retaliation

Sexual Misconduct/Assault

Sexual Harrassment

Persons Involved:
Please use this section to list the names of the parties involved as well as any witnesses, etc. Enter as much information as possible.

Name or Organization	Role (Accused, Affected Individual, Witness, Other)	Email/Phone #




































































































Add more persons involved

Describe the incident as clearly as possible. Include a full description of the events, verbal statements made, the location, and what, if any, physical contact was involved. This narrative will be reviewed by the appropriate staff members at Lindsey Wilson College.

I hereby certify that the information I have provided is true and correct to the best of my knowledge. By submitting a complaint you agree that you have read and understand that: (a) filing a false report is a crime punishable as a Class A Misdemeanor in accordance with §519.040 Statute of the Code of Kentucky and (b)knowingly furnishing false information to the College, omitting relevant or necessary information to gain benefit, to injure, or defraud is prohibited and subject to appropriate action (c) information you provide may be shared with, but not limited to, Title IX Coordinator, Office of Student Services, police, state and federal agencies, and involved individual's parent or guardian pursuant to KY. acts ch. 99, sec.134, where applicable and permitted by law.

Signature:

Date: