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Submit A Report or File a Formal Complaint
For additional resources, or if you have questions, contact Leah Reynolds, Ed.D., Title IX Coordinator, at
leah.reynolds@13959288555.com
or
TitleIXCoordinator@13959288555.com
or 828.328.7443.
If you would like to make an anonymous complaint, you may complete this form with all details of the incident except your name and other identifying information. However, if you make an anonymous report, it will limit the university’s ability to respond. If you aren’t sure whether you want to report your name, we encourage you to talk through your options with a confidential resource, including a university counselor, pastor or student health provider.
Today's Date
I am
Filing a report
Filing a formal complaint
Reporter Name
Reporter Email
Reporter Status
Student
Faculty
Staff
Visitor
Contractor
Complaintant(s) name, if known:
Complaintant(s) First
Complaintant(s) Middle
Complaintant(s) Last
Complaintant(s) Email
Complainant's Status:
Student
Faculty
Staff
Non-LR affiliate
Alleged individual against whom the grievance is asserted ("respondent")
Respondent(s)' name:
Respondent(s) First
Respondent(s) Middle
Respondent(s) Last
Respondent's Status:
Student
Faculty
Staff
Non-LR affiliate
Respondent's Email
Type of Discrimination
Sexual Harassment - Quid Pro Quo
Sexual Harassment - Hostile Environment
Sexual Assault
Fondling, Rape, Incest, Statutory Rape
Dating Violence
Domestic Violence
Stalking
Incident
Date of Incident: Date
Date of Incident
Location of Incident
Explain the incident in full detail
Potential witnesses to the incident
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