Title IX Reporting Form

This form should be completed and submitted as soon as possible after learning of an incident that may violate the University Policy. This form is completed by responsible reporters, as defined by our Title IX Policy, or third parties. If you experienced prohibited conduct and want to report, please complete the Formal Complaint Form for Discrimination, Sexual and/or Gender-Based Misconduct or Title IX Violations.

If you have questions about completing this form, please contact the Title IX Coordinator at: titleix [at] desu.edu.

If you have any questions or concerns, contact:

Mijrane Belizaire, JD 
Title IX Coordinator 
titleIX [at] desu.edu

Date of Incident: *
Time of incident: * :

Information about the Reporter

Reporter Physical Address