Sex Discrimination/ Sexual Harassment/ Sexual Assault Reporting Form

When submitted, this form will be emailed to the Title IX coordinator in the Student Equity Department for further action. You can reach the Title IX coordinator at (520) 225-4316.

School of Attendance

Student's first name: last name:

Student's grade:

Student's date of birth - Day / Month / Year

Parent's first name: last name:

Street address: Zip code: Phone:

Details of Complaint:

Name of alleged offender, if known - first name: last name:

Names of witnesses, if any:

First witness - first name: last name:

Second witness - first name: last name:

Third witness - first name: last name:

Other witnesses:

Witness contact information (phone, address, email), if known:

Contact info for first witness:

Contact info for second witness:

Contact info for third witness:

Contact info for other witnesses:

Date of alleged conduct/event: Day / Month / Year

Time of alleged conduct/event:

Location of alleged conduct/event:

Detailed Description of Alleged Conduct: