Report a Title IX Incident

If you or someone you know has been the victim of sexual harassment or sexual violence, please submit a report. If you believe there is an immediate threat of further violence, please contact your local police department or call 911.

Learn more about your options and resources.

Information that is not required can be left blank if you wish to remain anonymous.

Name Name First Last
Your role at JWCC

Your role at JWCC Student Employee Other Other
Phone Phone - ### - ### ####
Email
Best way to follow up with you

Best way to follow up with you Phone Email In-person
Nature of this report/description of the incident (who, what, when, where, how)
Date of incident Date of incident / MM / DD YYYY
Time of incident
Location of incident
Add supporting documentation (e.g. photos, videos)

Attach Files
Involved Parties
Name Name First Last
Gender

Gender Male Female Unknown
Role

Role Alleged Victim Witness
Name Name First Last
Gender

Gender Male Female Unknown
Role

Role Alleged Victim Witness
Name Name First Last
Gender

Gender Male Female Unknown
Role

Role Alleged Victim Witness
Reporting Parties may elect to have an Advisor present at meeting(s) and/or interview(s). If you indicate you will have an Advisor, you are authorizing that individual to accompany you to any meeting(s) and/or interview(s) regarding this report. The role of the Advisor is limited to observing and consulting with you. If you have selected an Advisor, please provide the name and telephone number of your Advisor.
I certify that the information given in this report is true and correct to the best of my knowledge.
By typing in my name below I am providing electronic signature that I have filled out this form and approve of the authorization made above.

Draw or Type

NOTE: Please enter "anonymous" as your name, if you are reporting anonymously. Clear

Full Name

NOTE: Please enter "anonymous" as your name, if you are reporting anonymously.
Would you like to be emailed a copy of this report? (must have filled out email on this form)

Would you like to be emailed a copy of this report? (must have filled out email on this form) Yes, email me a copy of this report

Report a Title IX Incident

Report a Title IX Incident

Involved Parties