lorraine.jones@rccd.edu 951-328-3874
Georgina Villaseñor-Lee
georgina.villasenor-lee@rccd.edu 951-328-3725
Danielle Sanders danielle.sanders@rccd.edu DO: 951-222-8591/RCC: 951-328-3703
Shannon Minter shannon.minter@rccd.edu DO: 951-222-8356/NC: 951-739-7801
silvester.julienne@rccd.edu DO: 951-222-8593/MVC: 951-571-6279
TITLE IX COMPLAINT/INTAKE FORM
This form can be completed for purposes of filing a complaint of sexual misconduct under Title
IX. Although we cannot guarantee complete confidentiality, Riverside Community College
District will take steps to keep an environment that is free from sex discrimination.
COMPLAINANT’S INFORMATION
Name: ____________________________ Student Employee Other:___________
Phone #:___________________________ Email: _______________________________
RESPONDENT’S INFORMATION
Name: ____________________________ Student Employee Other:__________
Phone #:___________________________ Email: _______________________________
TELL US MORE ABOUT THE INCIDENT:
Where did it take place? _______________________________________________________
When did the incident occur? ____________________ What time? _________________
Describe the incident in as much detail as possible: __________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Are there any witnesses to the incident or anyone you have told about the incident? If so,
please provide names._________________________________________________________
___________________________________________________________________________
Was the incident reported to College Safety & Police or any other law enforcement agency?
Yes No Unknown If other law enforcement agency, which one: ____________
Form Completed by (name): _______________________________ Date: ________________
Phone #:___________________________ Email: ________________________________
I am the: Complainant Reporter Witness Other:___________________
Please use a separate sheet if more space is needed.
You may submit this form to a Title IX Coordinator.
