Sexual Harassment and Discrimination Complaint Form

Do not use this form to report events presenting an immediate threat to life or property. If you require emergency assistance, please contact Campus Safety and Security at (304) 829-7744.

Why use this form?

This form is available for making complaints of harassment, including, but not limited to sexual violence and discrimination that you believe may be in violation of Bethany College’s Title IX/Sex Discrimination Policy. Complaints may also be made directly to the Title IX Coordinator by phone at (304) 829-7621 or by email at titleIX@bethanywv.edu.

Who should use this form?

This form can be used by students, faculty, staff, and visitors wishing to make a complaint on their own behalf.

I want to make a complaint on my behalf of someone else, and this does not seem to be the right form. What should I do?

If you want to bring a complaint on behalf of someone else (i.e. if you have witnessed a possible violation of the policy or had such a violation reported to you), please use the Bethany College Sexual Harassment and Discrimination Incident Report Form.

What happens after I fill out this form?

The information is sent to the Title IX Coordinator, who will determine what, if any, action by the college is necessary. You will ordinarily receive a follow-up message from the Title IX Coordinator within three business days.

Is the information in this form confidential?

The College will make every effort to protect the privacy of all involved, but the information you provide by completing this form is not confidential and may be shared as necessary for the College to take appropriate action.

File a Complaint

*
*
*

I wish to report possible discrimination/harassment in violation of Bethany College's Nondiscrimination and Anti-harassment Policy based upon:

*






Against whom are you filing this complaint? Please list the name(s) of the individual(s) you believe violated the policy. For each name, write the person's status (i.e., student, faculty, staff, campus visitor), if known.

*

When did the incident(s) occur? Be as specific as possible.

*
*

Please describe the incident(s). Be as specific as possible about what happened, including information about the people involved.

*

Were there any witnesses to the incident(s)? Please list the name(s) of the individual(s) you believe may have information that is relevant to the investigation. For each name, please write the person's status (i.e., student, faculty, staff, campus visitor), if known.

*

What action/remedy are you seeking? Please let us know if you need any immediate assistance as well as what you desire for the longer term.

*