Reporting & Forms

File a Complaint

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 304.829.7131 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.

First Name*
Last Name*
Your status*
Phone number*
Email address*
I wish to report possible discrimination/harassment in violation of Bethany College's Nondiscrimination and Anti-harassment Policy based upon:
Select all that apply*
- Sex/Gender (Includes claims of sexual misconduct)
- Sexual Orientation
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.
List names and status*
When did the incident(s) occur? Be as specific as possible.
Dates and times*
Where did the incident(s) occur*
- Campus building or grounds
- Residence hall
- Off campus
Please describe the incident(s). Be as specific as possible about what happened, including information about the people involved.
Describe the incident*
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.
List witnesses and status*
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.
Action/remedy*
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Name
This field is for validation purposes and should be left unchanged.

File an Anonymous Report

Purpose of this report*
- For information only
- Action expected
Date of incident*
MM slash DD slash YYYY
Location of incident
Be as specific about what happened as possible, including information about the people involved. If the complainant/victim has not consented to having his/her name revealed, do not use any real names or provide any other identifying information in your description. Instead use language like the following: "Jane Doe reported to me that on June 5, 2013, John Doe..." Otherwise, feel free to use real names. Please include all pertinent facts, behaviors, comments, gestures, markings, clothing, or other distinguishing characteristics.
Description of incident*
What do you consider the reason for this incident?*
- Sex/Gender (includes claims of sexual misconduct)
- Sexual Orientation
- Other
Other
Nature of incident*
Other
Victim Information
Sex of victim
- Male
- Female
Victim's race/ethnicity*
Full name of victim (if victim consented to disclosure)
Victim's affiliation to Bethany
Other
Please list any additional victim information
Alleged Perpetrator Information
Sex of the perpetrator*
- Male
- Female
Perpetrator's race/ethnicity
Full name of alleged perpetrator (if victim consented to disclosure)
Alleged perpetrator's affiliation to Bethany
Other
Please list any additional alleged perpetrator information
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Email
This field is for validation purposes and should be left unchanged.

File an Incident Report

First Name*
Last Name*
Your Status*
Your Phone Number*
Your Email Address*
I wish to report possible discrimination/harassment in violation of Bethany College's Nondiscrimination and Anti-harassment Police based upon:
Select All That Apply*
- Sex/gender (includes claims of sexual misconduct)
- Sexual orientation
What is the status of the complainant/victim on campus?*
What is the status of the respondent/accused on campus?*
I am: (If you are a victim/complainant, please use Bethany's Harassment and Discrimination Complaint Form)*
Other
How did you come to learn of the incident(s)*
- The complainant or victim reported the incident(s) to me.
- A third party reported the incident(s) to me.
- I witnessed the incident(s)
On what date did you learn of the incident(s)?*
MM slash DD slash YYYY
Did you ask the complainant if he/she wishes to make a formal complaint requesting the College take action?*
Where did the incident(s) occur?*
Please describe the incident(s) at issue. Be as specific about what happened as possible, including information about the people involved. If the complainant/victim has not consented to having his/her name revealed, do not use any real names or provide any other identifying information in your description. Instead use language like the following: "Jane Doe reported to me that on June 5, 2013, John Doe..." Otherwise, feel free to use real names.
Incident description*
If he or she consented to having his or her name revealed, provide the following contact information, if known, about the complainant/victim: Full name; phone with area code; email address:
Victim information
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Comments
This field is for validation purposes and should be left unchanged.

File an Appeals Form

If you have had a hearing and are appealing the decision, please print, complete and submit the Title IX Appeals Form.

If you are in need of immediate assistance, please find a safe place and call Campus Safety and Security at 304.829.7744 or 911.

File a Complaint

File an Anonymous Report

File an Incident Report

File an Appeals Form

Contact Bethany