Arkansas Tech University
Sexual Misconduct and Harassment Complaint Form
It is the policy of Arkansas Tech University to maintain the University community as a place of work and study for students,
staff, and faculty free of harassment, including sexual and gender harassment and all forms of sexual intimidation and
exploitation. All students, staff, and faculty should be aware that the University is concerned and prepared to take action to
prevent and correct such behavior.
Official Notice
Filing a complaint either formally or informally is considered to be official notice to the University. By making this report you
are authorizing the Title IX coordinator to conduct an investigation into the allegations laid forth. All complaints are considered
serious in nature and will be investigated completely with resolutions administered by the University.
Investigations are conducted on a need to know basis. This means that a formal complaint is not considered confidential;
however, only information that is necessary to the investigation will be shared with administrators, witnesses, and the accused
individual as required by law. The University provides two options for reporting and resolving matters involving gender
discrimination: informal resolution process and a formal complaint process.
Informal Resolution Process
Informal resolution may be appropriate when the conduct complained of is not of a serious or repetitive nature and disciplinary
action is not required to remedy the situation. As there is no formal investigation involved in the informal resolution process,
there is no imposition of discipline. University methods for resolving complaint informally include, but are not limited to:
Mediating between the victim and the individual who is engaging in the offensive conduct;
Aiding in the modification of the situation in which the offensive conduct occurred;
Assisting a department or division with the resolution of a real or perceived problem; or
Arranging for a documented meeting between the person allegedly engaged in the offensive conduct and a University
official that involves, at a minimum, a discussion of the requirements of the Sexual Harassment policy.
The University will document any informal resolution. The documentation will be retained by the Title IX Coordinator. The
documentation will be kept confidential to the extent permitted by law. An informal resolution meeting is not a precondition
for filing a formal written complaint. To pursue this method of resolution contact the Title IX Coordinator.
Formal Complaint Process
An individual who believes that he or she has been subjected to gender/sexual discrimination may submit a written formal
complaint setting forth all pertinent facts to the Title IX Coordinator who will review and investigate the facts presented.
Timely Warning Notifications
Complainants of gender/sexual discrimination should be aware that certain crimes may prompt an emergency notification by
the University to the campus community. If it is determined that a specific danger to the campus community or specific
segments of the campus community exists, an appropriate notification will be made. The victim's name and other personally
identifiable information will not be disclosed.
The Clery Act
The Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act, more commonly known as the Clery Act,
requires institutions of higher education to distribute to all current and prospective students and employees two types of
information: (1) Descriptions of policies related to campus security, and (2) Statistics concerning specific types of crimes. The
law requires the disclosure of crimes that are reported to police and to campus officials other than police, along with a
breakdown of locations of criminal activity to be specified as on-campus, non-campus, residence hall, or public property.
Personally identifiable information will not be disclosed.
Filing of a False Complaint
Individuals whose complaint is found to be both false and have been made with malicious intent will be subject to disciplinary
action which may include, but is not limited to, demotion, transfer, suspension, expulsion or termination of employment.
Once this form is received the Title IX Coordinator will contact you to set up an initial meeting so please provide accurate
contact information. You are welcome to bring a person of support to the meeting as well as any additional evidence or
information. Although the completion of this form would be beneficial prior to the first meeting, it is not required.
Print Form
Submit by Email
By submitting this form, I acknowledge that I am filing a written formal complaint and have read and understand
the practices and statements above. I also certify that the information given is true and complete to the best of my
Phone Number:
Report submitted By:
Detailed Information:
Victim Information:
Employee Student Other
Define Other:
Name: Tech I.D. Number:
City, State, Zip:
Respondent/Accused Information:
Employee Student Other
Define Other:
Tech I.D. Number:
Phone:City, State, Zip:
Witness Information:
Employee Student Other
(Completion of every field is not required, but please provide as much information as possible)
Employee Student Other
Employee Student Other
Employee Student Other
(additional witness information may be provided at a later date)
Define Other:
Interim Requests: (During the investigation and prior to the determination of a policy violation, you may request a temporary remedy)
No Contact Order Relocation ( work/residence hall ) Schedule Change (class/work shift) Other
Define Other:
On the following page please provide detailed information regarding the events that occurred. Remember to include
important details, such as, dates and times of all incidents, locations, witnesses present, etc. Please attach additional
pages if you would like to provide more information than the space will allow.
(If there is more than one respondent, please check other. In the Define Other box please put "multiple" and list
all individuals in the box provided on the following page.)
Define Other: Define Other:
Define Other: Define Other:
Desired Outcomes:
(if submitted by email, signature may be obtained at the first meeting)