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UMaine Title IX Mandatory Reporting Form

This form should be used to report concerns pertaining to students or UMS employees who have experienced dating violence, domestic violence, hostile environment, sexual assault, sexual exploitation, sexual harassment, stalking, retaliation, or other forms of sexual misconduct. The entire University of Maine System policy against sex discrimination is available here.

All University of Maine employees are Mandatory Reporters with the exception of the licensed, clinical counselors and their clinical interns. If a student or a staff member has disclosed to you that they are involved in or have previously been involved in a Title IX situation, you must submit a report. This enables UMaine to provide resources and assistance to those individuals and does not get the individual into "trouble" of any sort.

UMaine respects the sensitivity of the information that may be included in this form. Filing this incident report only notifies a limited number of University officials: Title IX Student Services and the Office of Community Standards, Rights and Responsibilities. Please note that as mandated by Title IX as a federal law, the information included in this form is not confidential, but will be kept as private as possible in all efforts to protect individuals and the greater University community.

Completing this report does not substitute filing a report with the UMaine Police Department or local police. To file a report with UMaine Police, please call 207-581-4040. UMaine Police can assist in privately contacting local police if necessary.

If you are unsure or would like to speak to someone about completing this report form, please call Deputy Title IX Coordinator, Heather Hogan, at 207-581-1406.

TO REPORT AN EMERGENCY OR IF YOU ARE REPORTING AN INCIDENT THAT POSES AN IMMINENT RISK OF HARM TO A PERSON(S) OR PROPERTY CALL 911/POLICE BEFORE COMPLETING THIS FORM.

Background Information

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Your full name:

Your position/title:

Your phone number:

Your email address:

Your physical address:

Nature of this report(Required):

This field is required.

Urgency of this report(Required):

This field is required.

Date of incident(Required):

This field is required.

Time of incident:

Location of incident(Required):

This field is required.

Specific location:

Involved Parties

Name or Organization

Select Gender

Select Role

ID Number

DOB (YYYY-MM-DD)

Phone number

Email address

Hall/Address

Questions

Please indicate the nature of the incidents you are reporting.(Required)

Dating violence Domestic violence Hostile environment Sexual assault Sexual exploitation Sexual harassment Stalking Retaliation Other

You must make at least one selection.

Please provide a detailed description of the incident/concern using specific concise, objective language (Who, what, where, when, why, and how).(Required) This field is required.

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Email me a copy of this report