• Dr. Ruth E Gonzalez, Title IX Coordinator.
• It is strongly advisable to submit this report of disclosure to Dr. Ruth E Gonzalez, Title IX Coordinator located in Greenwoods Hall Rm 209 within 48 hours of being informed of the incident.
General Category of Report/Disclosure
Intimate Partner Violence
Date of Report/Disclosure
Name of Student
You may use initials only for Disclosure only. Identity will not be disclosed except in very limited circumstances
Banner ID (optional)
RECOMMENDATION/EXPECTED ACTION OF REPORTER
Recommendation/Expected Action of Reporter
Disclosure Only: Share information without a request for conduct investigation
Filing a Report: Investigation and action by College requested
What resources were provided to the student/employee affected?
Would you like to be contacted by the Title IX coordinator, Dr. Ruth E Gonzalez?
How would you like to be contacted? (cell phone, email, meeting etc.)
Please enter any two digits, Example: 01
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