TITLE IX REPORTING FORM

Reporting Title IX/ Sexual Misconduct: Sexual Assault, Dating and Domestic Violence, Stalking, including Discrimination, Harassment, and Retaliation

We take incidents of sexual misconduct and gender and other  discrimination seriously as an institution.  Please know that your concern will be responded to within the time frame listed. This form is used to report incidents of domestic and dating violence, sexual assault, stalking and discrimination or harassment of sex and gender-based concerns.

Looking to report anonymously? Click Here.

Directions for completing the Adobe fillable form: Adobe icon image

**If you  receive a message stating the PDF cannot be read,  select Open With Different Viewer from upper right part of the website.

  • Select  and save file as: Title IX Reporting Form from a computer (form may not open with all mobile devices.
  • After completing the form, use the purple submit form button located at the top of the page and follow the prompts to submit your form by email.

Title IX Reporting Form2017_Web_distributed_2

OR

Return Form: Save completed form, scan and send to LMcghee@rockford.edu

You also have the option to bring or mail the form to:

Rockford University
Compliance and Title IX Office
5050 E. State Street
Rockford, IL 61108

DEPARTMENT INFORMATION

Office of Compliance and Title IX

LaShun McGhee
Compliance and Title IX Coordinator
815-226-2842
Burpee Center, Student Life Suite 5050 E. State Street Rockford, IL 61108

LMcGhee@rockford.edu

Hours:
Mon-Fri- 8:30am to 5:00pm