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  • Check box to receive a copy of the submitted application.

Status

  • Student
  • Faculty
  • Staff
  • Other

Status

  • Student
  • Faculty
  • Staff
  • Other

Please select the type of complaint you are filing:

  • Title IX Discrimination/Harassment
  • Student Code of Conduct Violation

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:

  • Sexual Misconduct
  • Sexual Harassment
  • Sexual Violence
  • Domestic Violence
  • Dating Violence
  • Stalking
  • Race/Color
  • Age
  • Gender
  • Disability
  • Sexual Orientation
  • Religion

Please check box(es) that apply to the Student Code of Conduct Violation you are reporting: Parker University Student Handbook pages: 161-165:

  • (A) Academic Dishonesty
  • (B) Obstruction of Instruction
  • (C) Unauthorized Use
  • (D) Damaging Parker Property
  • (E) Theft/damage
  • (F) Adverse/Criminal Law
  • (G) Student Obligation
  • (H) Copyright Laws
  • (I) Abuse/Harassment
  • (J) Hazing
  • (K) Firearm Possession
  • (L) Knife/Blade 5 ½
  • (M) Selling Drugs
  • (N) Smoking/Tobacco
  • (O) Unauthorized Alcohol
  • (P) Obscene Phone/Offensive Clothing
  • (Q) Tampering Fire Alarms
  • (T) Abuse of Computers/Technology
  • (U) Abuse of Judicial System
  • (V) Adjusting without Supervision
  • (W) Patients Properly Draped
Witness First Name Witness Last Name Witness Email Witness Phone Number
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Have you made any prior attempts to formally or informally resolve this issue prior to filing this complaint form?

  • Yes
  • No
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