Title IX/Equal Opportunity Report Form

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TITLE IX/Equal Opportunity Report Form

This form can used to report information of alleged sexual harassment, sexual assault, domestic or dating violence, stalking, or retaliation pursuant to the MCLA’s Equal Opportunity, Diversity and Affirmative Action Plan (EO Plan) Title IX Sexual Harassment Policy. All reasonable efforts will be made to maintain the involved parties’ privacy during the investigation and resolution procedure.

It is a violation of MCLA Policy to retaliate against a student, employee, or any other person affiliated with the College for filing a complaint or for cooperating in the investigation of a complaint.

This form should not be used in situations where immediate attention is required. In the event of an emergency, please call 911 or contact MCLA Public Safety at (413) 662-5100. Submissions of this form are not monitored 24/7; submissions will be reviewed during normal business hours, excluding holidays.

Justin MacDowell

Director of Title IX and Equal Opportunity

Massachusetts College of Liberal Arts

375 Church Street, North Adams, MA 01247

Justin.MacDowell@mcla.edu

TitleIX@mcla.edu

413.662.5571

Making a Report
MCLA reviews every report brought to our attention. To help us respond to the report, please include as much of the following information as possible:
* Your name
* The name of the person experiencing the harassment or discriminatioun (if not you)
* The name of the person who is alleged to have committed the harassment or discrimination
* A Brief description of what happened or of the concern

If you are making a report on behalf of someone else, thank you. MCLA will contact that person directly.

Please know that if you are forwarding a report that you saw on social media and your knowledge of that report is limited to what you have read or seen on social media and you do not have direct knowledge of what occurred, please let us know so that we do not work to contact you for more information.

Anonymous Reporting
You may submit this form anonymously. However, MCLA employees reporting on behalf of a student or employee must provide their name to fulfill their reporting responsibilities. Without contact information, we are unable to contact you for follow up, and the college's options for response to the report will be limited.

Reporter information

1. Date filed:

2. Date(s) of alleged incident(s):

3. Reporter's name:

4. Reporter's position/title

5. Reporter's phone number:

6. Location of incident:

Involved Parties
7. Please list the individuals involved, including as many fields as you can provide. For non-students, please list as much information as you have available. Do not create an ID number if you do not know it. "Respondent" is the individual/organization alleged to have committed the behavior.

Complainant/Victim

Accused/Respondent

Witness

Other

Description/Narrative

8. Victim/Complainant's Relationship to MCLA:

9. Accused/Respondent's Relationship to MCLA:

10. Type of alleged prohibited conduct

11. If the complaint is based on discriminatory or harassing behavior based on any of the following protected categories, please list any and all that apply here. (Race, Age, Sex or Gender, Color, Disability, Sexual Orientation, Religion, Genetic Information, Gender Identity, National Origin, Veteran's Status, Gender Expression, Marital or Parental Status)

12. Please describe the incident in as much detail as possible:

13. Has this complaint been reported to anyone else and whom?

14. What remedy are you seeking?

15. To the best of my knowledge and belief, the above information is complete, true, accurate, and not a “false charge” as defined under the EO Plan.

Supporting Documentation
Please identify and attach any documents or other evidence regarding the alleged acts, such as e-mails, correspondence, text messages, social media posts, or other materials.

Attachments require time to upload, so please be patient after submitting this form.

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What Happens After You Make a Report
Once we receive a report, we send an email to the individual who experienced the harassment or discrimination. In that email we include an invitation to meet with us to discuss what steps we can take to address the situation and provide campus and community resources available to assist.

For information on the process after the initial report, visit https://www.mcla.edu/administration/title-ix/procedures.php

For MCLA Title IX and Equal Opportunity resources, please visit https://www.mcla.edu/administration/title-ix/

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