SUBMIT A COMPLAINT/REPORT

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Complainant Information:
Nameyour full name
Phone #
Email
Student ID (if applicable)
Faculty/Staff Dept. and Pos. (if applicable)
Incident reported to you by (if applicable):
Victim/Survivor Information: (if different from above)
Name
Phone #
Email
Student ID (if applicable)
Faculty/Staff Dept. and Pos. (if applicable):
Gender:
Respondent #1 Information

(if known, please provide information below)

Name
Phone #
Email
Student ID (if applicable)
Faculty/Staff Dept. and Pos. (if applicable)
Gender
Relationship to victim
Respondent #2 Information

(if known, please provide information below)

Name
Phone
Email
Student ID (if applicable)
Faculty/Staff Dept. and Pos. (if applicable)
Gender
Relationship to Victim
Incident Information:
Dateof appointment
Location of Incident


Describe the incident as clearly as possible (who, what, where, when, and how). Include a full description of the events, verbal statements made, the location, and what, if any physical contact was involved. If there has been a pattern of behavior or multiple incidents, please note that in this section:

Description of Incident Heremore details
0 /


List names and contact for any witnesses who were present or may be able to provide relevant information:

List Names Heremore details
0 /
Have you report the incident(s) to any of the following?
Certification:
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You do not have to use this form to make a complaint, report wrongdoing, or receive assistance. You may contact the local police department, Title IX Coordinator(s), Title IX Officer, or Campus Security Authority, directly. You may also use Vatterott’s anonymous reporting line, Ethics Hotline at 1-866-243-8610 (or St. Louis local 314-264-1874).

This form is to be used to report sexual harassment, sexual violence, stalking, domestic violence, dating violence, or incidents of sex-based discrimination. If you or someone you know has been the victim of any of these, you are encouraged to bring it to the attention of the Title IX Coordinator and/or other Vatterott official. If you would like to initiate a police investigation of sexual assault or other crime, please call 9-1-1 if it is an emergency, or your local police department as soon as possible.

Vatterott’s Title IX Coordinator is available to answer your questions about your options, processes and resources, ensure an appropriate investigation is made, as well as to provide guidance and referrals. The Title IX Coordinator may contact you in response to your submission of the report.

Please fill out as much information as possible based on your knowledge of the situation. You may submit an anonymous report, however without the contact information of the complainant and the ability to investigate further, the College may be limited in how it can respond. At all times, the College will make every effort to protect the privacy of all involved.

The following terms are used below:

  • Complainant – the person who submits the report. The complainant may be the victim, a witness, bystander, or other person who knows about the incident or situation.
  • Victim/Survivor – the person who experienced the violation or harm.
  • Respondent – the person accused of perpetrating the violation or harm. If there are more than 2 respondents, please note that in the description of events.
  • Witness – a person who saw or heard an incident occur or who has relevant information about it.

Contacts:
Title IX Coordinator – Megan Wilson
8580 Evans Avenue
Berkeley, MO 63134
314-264-1874
titleixcoordinator@vatterott.edu

Title IX Officer (Campus Director)
Title IX Officer (Campus Director)
For contact information regarding each location’s Campus Director, please call 314-264-1500 or visit www.vatterott.edu/campuses.asp