First Name
Last Name
Student ID #
Contact Phone
Email Address
Contact Address
Status
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College/Major
Please select the type of complaint you are filing:
Please check box(es) that apply to the type of Title IX Discrimination/Harassment you are reporting: Parker University Title IX Policy pages: 170-174:
Please check box(es) that apply to the Student Code of Conduct Violation you are reporting: Parker University Student Handbook pages: 161-165:
Witness First Name
Witness Last Name
Witness Email
Witness Phone Number
Please provide specific details about the policy violation you are reporting. To the best of your knowledge, please include name(s), date(s), time(s), and location(s). Please use additional forms if more space is needed:
Please list any evidence (texts, emails, notes, voicemails, pictures, videos etc.) you have that will support your complaint:
Please attach evidence using the upload button below:
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Have you made any prior attempts to formally or informally resolve this issue prior to filing this complaint form?
If yes, please summarize the action(s) you have taken:
Please describe how you would like to see this situation/complaint resolved: