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Prohibited Sexual Misconduct & Sex/Gender-Based Harassment & Discrimination Incident Reporting Form


Please use this incident reporting form to report any form of Prohibited Sexual Conduct and Sex/Gender-Based Discrimination and Harassment committed by an FSU student to FSU's Title IX Office. 

 

If you desire to file a report regarding any other type of non-academic misconduct by a FSU student, please CLICK HERE to be routed to the Student Conduct Office. 

As described in the University'sProhibited Sexual Misconduct & Sex/Gender-Based Harassment and Discrimination Policies and Procedures, you may also submit your report using the following options:  

    • Visit:      Barber Building, Office 242
    • Call:      (910) 672 - 2325
    • Email:   TitleIX@uncfsu.edu
    • Teams:  @TitleIX
    • Mail:      Title IX Office c/o FSU | Barber Building - 242 | Fayetteville, NC |  28301

 


Please include your name so that FSU's Title IX Office may contact you about any follow-up questions that they may have about your report. However, if you wish to remain anonymous, and not include your name, FSU's Title IX Office will still begin the process of addressing the report. The information contained within your report may be shared with University Officials with a legitimate educational purpose to know this information, and with those to whom we are required by law to make disclosures. Submitting your report constitutes official notice to the University and authorizes the Title IX Office to begin the process of addressing the information, concerns, and/or allegations contained within your report. To learn more about the Univeristy's Prohibited Sexual Misconduct & Sex/Gender-Based Harassment and Discrimination Policies and Procedures, please visit www.uncfsu.edu/title-ix-policies 

 

Please note, if a crime has occurred, you are encouraged to file an official police report with the Fayetteville State University Department Police and Public Safety by calling 910-672-1775 or visiting the Mitchell Building - 24 hours per day, 7 days per week. You may also file an official police report with the City of Fayetteville Police Department by calling 910 -433-1529 or visiting 467 Hay St, Fayetteville, NC 28301, and/or other Law Enforcement Officials in your local area (To learn more, please visit https://www.uncfsu.edu/life-fsu/our-campus/campus-safety).  

  

Submitting this report notifies the following University Offices:

  • Office of Legal Affairs
  • Title IX Office

Background Information

Please complete all information below.

 
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Involved Parties

Please list all parties involved (excluding yourself) and provide as much information as possible. If you do not have information for a certain field, please continue to submit the report; the information will be researched once the report is received.

Roles in which the parties may be involved include the following:

  • Respondent is defined as an individual who has been accused of violating FSU Policies
  • University Faculty or Staff is defined as an individual who is employed at FSU as faculty or staff.
  • University Student is defined as an individual who attends classes at FSU.
  • Complainant is defined as an individual to whom the misconduct was directed.
  • Witness is defined as individual who observed the alleged behavior and can provide additional information.
  • Reporter – is defined as the person reporting the information.

Please fill in the information you can provide about all the individuals involved (including yourself -- if applicable).

Involved party 1

Description

Please complete each question below to the best of your ability. 

1. Are you reporting this incident for yourself or for another person?(Required)
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2. What is the nature of this report? (please select all that apply)(Required)
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3. Do you feel this behavior happened because of: (please select all that apply)(Required)
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6. Please select one of the following: (If you are a Responsible Employee (see reporting requirements for University Administrators - www.uncfsu.edu/title-ix-policies), please ensure you have read and understand your responsibilities.)
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7. Do you want the FSU Policy and Public Safety Department to contact you and follow up on this information. (Please note, this option is available for incidents occurring on FSU campus property only).(Required)
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8. If you want police follow up, please select the best form of communication. (Ensure contact information is provided above.)
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Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission