Accessible Report Form

Accessible Report Form

By using this online reporting form, you are submitting information to the University of Illinois Title IX and Disability Office.  If the incident involves an employee, the Office of Diversity, Equity, and Access will also be notified.   

A time-sensitive incident may warrant an immediate response.  If there is an immediate risk to health or safety, please call 911 to connect with medical support or local law enforcement.  Reports submitted through this link may not be reviewed outside of normal business hours or immediately. 

If you prefer not to use the online reporting, need assistance in completing this form, or encounter accessibility problems with the form, please call the Title IX and Disability Office at (217) 333-3333 for assistance.

Anonymous Reporting

An individual may report an incident without disclosing his/her name, identifying the respondent, or requesting any action. Please note that choosing to make an anonymous report can significantly limit the ability of the University to respond. This information will be used for statistical purposes as well as for enhancing understanding of our campus climate so that we may strengthen sexual misconduct response and prevention efforts.

Responsible Employees

Responsible employees must immediately report allegations or disclosures of sexual misconduct involving students to the Title IX & Disability Office. Because the definition of responsible employee is so broad, you should consider yourself a responsible employee unless you qualify as a confidential resource. (Confidential resources on campus include the Counseling Center, the Women's Resources Center, and McKinley Health Center.)

Reporter Contact Information

While reporters can submit reports anonymously, we encourage reporters to provide contact information in case more details are needed.  Please note that there are limitations to addressing concerns by reporting anonymously.

While reporters can submit reports anonymously, we encourage reporters to provide contact information in case more details are needed.  Please note that there are limitations to addressing concerns by reporting anonymously.

 

 

 

 

5. Reporter's Affiliation

5. Reporter's Affiliation

Complainant (Victim/Survivor) Contact Information

Complainant refers to the individual(s) who is alleging a violation of University policy or who claims to have been or is perceived to have been a victim/survivor of sexual misconduct.

6. Is the Complainant information the same as the Reporter?

6. Is the Complainant information the same as the Reporter?

 

 

 

 

11. Complainant's Affiliation

11. Complainant's Affiliation

Respondent Contact Information

Respondent refers to the individual(s) who is alleged to have violated the sexual misconduct policy. Please provide any contact and/or descriptive information to help with identification.

 

 

 

 

16. Respondent's Affiliation

16. Respondent's Affiliation

Other Individuals Involved and Witnesses

Please list any other involved individuals (including additional respondents, complainants, and witnesses).  Please include their name, contact information, and their role (such as witness), along with any other identifying information.

Please list any other involved individuals (including additional respondents, complainants, and witnesses).  Please include their name, contact information, and their role (such as witness), along with any other identifying information.

Sex-Based Discrimination, Harassment, or Misconduct

Please check all that apply

required18. Type of misconduct, discrimination, or harassment

required18. Type of misconduct, discrimination, or harassment

Please check all that apply

Time, Location, and Description of Concern

Provide as much information as you can (month, day, year, time, semester) about when the incident occurred. If you do not have any information about when the incident occurred, please write "Unknown."

Provide as much information as you can (month, day, year, time, semester) about when the incident occurred. If you do not have any information about when the incident occurred, please write "Unknown."

 

Please provide as much location information as you can below. If known, please include building or house name, address, street name, and/or cross streets.

Please provide as much location information as you can below. If known, please include building or house name, address, street name, and/or cross streets.

 

Please describe what occurred.

Please describe what occurred.

Resource Referral Information

Resource information and a brochure are available at the We Care website.  

required22. Was the We Care website or brochure shared with the complainant/victim?

required22. Was the We Care website or brochure shared with the complainant/victim?

Resource information and a brochure are available at the We Care website.  

Read about the rights and options of students who have experienced sexual misconduct.

required23. Were the Rights and Options shared with the complainant/victim?

required23. Were the Rights and Options shared with the complainant/victim?

Read about the rights and options of students who have experienced sexual misconduct.

Please provide any additional information that might be useful, including all additional information about any resources, referrals, support services, and/or accommodations requested, and any follow-up or actions already taken (or that you are intending to take).

Please provide any additional information that might be useful, including all additional information about any resources, referrals, support services, and/or accommodations requested, and any follow-up or actions already taken (or that you are intending to take).

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Title IX Coordinator Contact Information

For additional information and resources, please visit the We Care website. If you have any questions, please contact the Title IX Coordinator at (844) 616-7978 or email the Title IX Coordinator.