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Title IX/Sexual Misconduct Incident Initial Reporting Form



IF YOU ARE EXPERIENCING AN EMERGENCY, CALL NSU PUBLIC SAFETY AT 954-262-8999 OR THE LOCAL POLICE AT 9-1-1.


This form is used to report sexual or gender-based misconduct, including sexual harassment, sexual violence, stalking, or relationship violence to NSU in accordance with NSU's Title IX/Sexual Misconduct Policy. This form may be completed by someone who has been directly affected, a witness, or an NSU employee who has become aware of sexual misconduct in the scope of their role at NSU. The information provided will be sent the Title IX Coordinator, who will review the information by the end of the next NSU business/school day and will reach out to the affected individual(s) to discuss any immediate needs, resources for support, and options, including the formal complaint process under Title IX.

If something happened to you or someone else that is not related to sex or gender-based misconduct, please consider reported the information to Student Conduct, the Office of Human Resources, or an NSU University school official. Any incident reported here that is not related to Title IX/Sexual Misconduct will be referred to the appropriate NSU office or official. Reports of misconduct between employees will be forwarded to the Managing Director for Employee Relations.

If you have experienced sexual violence, you have a variety of rights and options available to you. If you are not sure whether you are interested in reporting the incident, please consider contacting a confidential resource such as Broward County's Nancy J. Cotterman Rape Crisis Center's 24-hour confidential hotline at (954) 761-RAPE or NSU Student Counseling at (954) 424-6911. A list of resources for each regional campus is available here. 

The privacy of this information will be maintained to the greatest extent possible, while allowing the university to respond appropriately to promote safety and accountability. If you would like to report this incident anonymously, just leave your name and any contact information blank, although please be aware that the IP address of the computer from where the report is submitted may be recorded. While NSU takes all reports of sexual misconduct seriously, the ability to follow up with you or regarding the information reported is limited if you do not provide your contact information. Employees reporting an incident are required to include their contact information, as well as the identities of the involved parties.

If you have any questions, you can email NSU's Title IX Coordinator. Students who prefer to speak to the Title IX Coordinator prior to or in lieu of completing this form can email titleIX@nova.edu to schedule an appointment. 

Background Information

Please provide as much information as you can and feel comfortable sharing. If you do not know or have information, just leave it blank. If you prefer to meet with the Title IX Coordinator to ask questions first, you can just email titleIX@nova.edu or fill in your contact information below and you'll receive a phone call or email to discuss the reporting process and your options. If you are an employee reported something a student disclosed to you, you must include all known details (including names of involved parties). This does not automatically initiate a formal complaint process, but the Title IX Coordinator needs this information to contact the affected person(s).

 
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e.g. student, faculty, staff, visitor, other
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The best number to reach you
Email address must be of a valid format.
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Person(s) who engaged in misconduct, caused harm, etc.
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Room number or other specific location

Involved Parties

To the best of your ability, please provide any known information about the person(s) involved, including those that may have committed or experienced sexual misconduct and any witnesses. If the incident happened to you, please include your own information. Click "add another" to add additional persons to the Involved Parties list.

Involved party 1

Questions

Please provide as much detail as you can or are willing to provide. Please be advised that any information you provide may be utilized in an NSU investigation which means at some point involved parties may be able to see this information.

Who was the sexual misconduct or sex-based discrimination directed towards? (check all that apply)(Required)
You must make at least one selection.
Please check which aspects of sexual misconduct/discrimination best seem to describe the behavior(s) that you are reporting (check all that apply):(Required)
You must make at least one selection.
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Supporting Documentation

Please add any documents, sound files, photos, videos, screenshots, or other information related to your report that you would like to share. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission