Report an Incident

To report an incident of a possible Title IX violation electronically, please complete the complaint form below.

Title IX Reporting Form

Please use this form to report a Title IX incident or a discrimination incident.

* First Name

* Last Name

* Phone Number

* Email

Street Address

City

State

Zip

* What is your relationship to MSJ?
Select an option Faculty Staff Student Vendor Visitor

I am the
Complainant Respondent Third Party

I believe I have been, I have witnessed, or I received information that discrimination and or harassment has taken place on the basis of:
Race Color National Origin Ancestry Religion Age Disability Sex Sexual Orientation Gender Identity or Expression Marital Status

For Title IX related incidents. Please check the box that most accurately reflects what you are reporting.
Sexual Misconduct Dating/Domestic Violence Stalking

* I believe I have been retaliated against because I opposed that which I believe to be unlawful discrimination in employment or education, filed a complaint, participated in an investigatory process, or reported such behavior required.
Yes No

Involved Parties
Please provide the names and roles of any individuals or organizations involved in the incident, as well as those who may have witnessed it. Please also complete as much of the other requested information as possible.

Click the button labeled Add Party to include more people.

Add Party

Please add at least one involved party.

Describe in detail each discriminatory and/or harassing behavior that occurred. Please include dates and locations of each action.

Please add at least one incident.

Add Incident

Describe what remedy/desired action you are seeking and why.

If you have any additional documents, emails, or other materials that will assist us in understanding your complaint, please email them to Paige Ellerman, Vice President Compliance, Risk, Legal Affairs/General Counsel/Title IX Coordinator at 513-244-4393, paige.ellerman@msj.edu

Attach a Files

Submit

 

You can report a Title IX related incident the following ways: Note: If you are designated as a Responsible Employee, you have the legal obligation of reporting the incident to the Title IX Coordinator.

Report to the Title IX Coordinator:

Paige Ellerman, Vice President Compliance, Risk, Legal Affairs/General Counsel/Title IX Coordinator can be contacted at 513-244-4393, paige.ellerman@msj.edu

Report to University Police:

Located: Ground Floor of the Seton Center
Phone: Campus Telephone: Dial 0
Cell Phone: 513-244-4200 for direct access to Campus PD
Dial 911 for emergencies.

Anonymous Reports- Not an option for Responsible Employees:

Call or Text: 513-244-TIPS (8472)
Email: 244TIPS@msj.edu