TITLE IX COMPLAINT FORM

Cloud County Community College (CCCC) is committed to providing a safe learning and working environment. In compliance with federal law, specifically Title IX, the Jeanne Clery Act (Celery Act) and the Campus Sexual Violence Elimination Act (SaVE Act), CCCC has adopted procedures to prevent and respond to incidents of sexual assault, domestic violence, cyberbullying, dating violence, stalking, and retaliation. Please provide as much information as possible in support of your claim. This form will be sent to the Title IX Coordinator and will help to ensure that your complaint is handled appropriately until it is resolved. You are welcome to attach documents with additional information.

Complainant (person filing the complaint)

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Respondent (person complaint is against)

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Witness Information

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Statement of Events

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Remedies Sought by Complainant

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Complaint Acknowledgement

 

I certify that, to the best of my knowledge, the information I have provided is accurate. I understand and acknowledge that a copy of the complaint (with attachments) will be provided to the respondent. I also understand and consent to the disclosure of this complaint to the appropriate administrators in order to investigate and resolve this complaint. I understand that this complaint and all discussions conducted throughout the course of the investigation are confidential to the extent permitted by law. I also understand that any unauthorized disclosures of this information could result in disciplinary action. I agree to abide by these guidelines.

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Title IX Coordinator
Beth Whisler
800-729-5105 ext. 262
bwhisler@cloud.edu