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Institutional Compliance Responsible Employee/Incident Report Form


This form may be used to submit a report to Institutional Compliance regarding potential violations of the University’s Nondiscrimination Policy (UTDBP3090) and/or Sexual Misconduct Policy (UTDBP3102).

  • Discrimination or harassment on the basis of race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, age, national origin, disability, genetic information, or veteran status
  • Sexual harassment, sexual assault, sexual exploitation, dating violence, domestic violence, stalking, or other sexual misconduct
  • Retaliation for filing a claim of discrimination or participating in a discrimination investigation or proceeding under UTDBP3030 or UTBP3102; or otherwise opposing a discriminatory practice

Once you submit this form, you may be contacted if additional information is needed. If a potential complainant (i.e., individual who may have experienced prohibited conduct as alleged in this report) is identified, we will contact this individual to discuss resolution options and supportive measures. Submission of a reporting form is not a formal complaint or grievance triggering an investigation process under UTDBP3090 or UTDBP3102. Regardless of the nature of your report, the University will ensure that your information is forwarded to the office with responsibility for responding to reports or concerns as appropriate, based on the information you have provided. The information you provide will be kept confidential to the extent permitted by law.

If this is an emergency, please call the UT Dallas Police Department dispatcher at 972-883-2222 or 9-1-1. If you have questions, please contact our office by email at TitleIXCoordinator@utdallas.edu.

Background Information

If you are making an anonymous report, and you are not a Responsible Employee, you may omit your contact information. Please note that the University’s ability to respond to anonymous reports is limited.

 
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Student, Faculty, Staff, Visitor, Other
Email address must be of a valid format.
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Your email address will be used to confirm your submission and follow-up with you, as needed
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What type of issue are you reporting?
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Select today's date if you do not know the date of the incident
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More details about the location (such as room number or name of online platform)

Involved Parties

Provide the name, contact information (email and phone), and UTD ID number (if applicable) for the following individuals described below.

  • Complainant - Individual(s) who may have experienced prohibited conduct.
  • Respondent - Individual(s) allegedly responsible for the prohibited conduct.

If you do not know the name of the Complainant or the Respondent, please type Unknown Complainant and/or Unknown Respondent in the name field. If you do not have all the information, provide as much information as you can.

Involved party 1

Report Information

Reporter type: I am a(Required)
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Have you reported this incident to anyone else?(Required)
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If you are submitting this report as a Responsible Employee, University Official, Administrator, or Supervisor, or Third Party, is the person who may have experienced prohibited conduct aware you are making this report?(Required)
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I understand in submitting this report that: You confirm the information contained within this report is accurate based on the knowledge you have and is being provided in good faith. A university official may seek additional information related to this report or refer it to another department as appropriate. The university may use this report in administrative and legal proceedings related to the information within this report. The university prohibits retaliation against anyone who in good faith submits a report, files a complaint, participates in any investigation or proceeding related to an allegation of prohibited discrimination, harassment, or sexual misconduct, or otherwise opposes a discriminatory practice. Interference with an investigation is also prohibited.(Required)
You must make at least one selection.

Supporting Documentation

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

Submission