Sexual Misconduct Title IX Complaint Form

As a recipient of federal funds, Paul D. Camp Community College (PDCCC) is required to comply with Title IX of the Higher Education Amendments of 1972, 20 U.S.C. § 1681 et seq. (“Title IX”), which prohibits discrimination on the basis of sex in educational programs or activities, admission and employment. Under certain circumstances, sexual misconduct, sexual harassment, and similar conduct constitute sexual discrimination prohibited by Title IX.

Employees, full and part-time, are required to report all incidents of Sexual Misconduct to a Title IX Coordinator. PDCCC’s Title IX Coordinators are: Phillip Bradshaw, Operations Manager, Room 106 Franklin Campus, 757-569-6744 and Trina Jones, Dean of Student Services, Deputy Title IX Coordinator, Room 126G Franklin Campus, 757-569-6720. If a student or other individual reports and incident to an employee, employees should:

  • Inform individuals that you cannot maintain confidentiality and that you must forward the report to the Title IX Coordinator.
  • Tell the person that he or she can discuss confidentiality with the Title IX Coordinator.
  • Provide information on available resources, or direct the person to where it may be located.
  • When appropriate, address the immediate needs of the individual.

Please provide as much detailed information as you can about an incident you are reporting. It is essential that names and contact information be provided to allow Title IX Coordinators and Security to investigate and provide assistance in a timely manner.

Sexual Misconduct Title IX Complaint Form printable version.

Sexual Misconduct Title IX Complaint Form

  • Information Regarding the Complainant

  • Information Regarding the Alleged Victim (if he or she is not the Complainant)

  • Information Regarding the Respondent

  • Information Regarding the Alleged Misconduct (sexual harassment, sexual violence, domestic violence, dating violence, or stalking)

  • You may wish to consider including, among other things, some or all the following information in your description: the gender of the parties, the relationship between the parties, whether one or more of the parties were under the influence of alcohol or drugs at the time of the alleged Misconduct, whether the Respondent used pressure or force (physical or otherwise) in the course of the alleged Misconduct, and the frequency (if applicable) of the alleged Misconduct.

Verification