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Sex-Based Discrimination/Misconduct Reporting Form


Clackamas Community College is committed to creating and sustaining a safe, inclusive environment for everyone.  

This form is for the reporting of relationship violence, sexual harassment, sexual misconduct, stalking, and/or discrimination.  

Any individual may report the incident without disclosing their name, identifying the responding person, or requesting any action. Depending on the extent of information available, the college's ability to respond to an anonymous report may be limited.

Please note reports are not reviewed after-hours, on weekends, or during holidays or breaks.  

If you consider this situation an emergency, call 9-1-1.  

If you are unsure about submitting this report or would like to speak to someone about completing this report, please get in touch with our Title IX team at titleIX@clackamas.edu.

 

 

General Background & Reporter Information

 
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You can put anonymous in this field
Email address must be of a valid format.
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Involved Parties

Please list the individuals involved (excluding yourself), including as many of the listed fields as you can provide.

Involved party 1

Questions/Additional Information

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Please indicate the following (check all that apply):(Required)
You must make at least one selection.
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Was a report filed with CCC College Safety?(Required)
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What is the resolution or set of resolutions you are seeking as a result of submitting this report?(Required)
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How would you prefer our Title IX Team follow up with you? (Please ensure preferred method of contact information is listed in General Background/Reporter Information section.)(Required)
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I understand that this report will only be reviewed during normal business hours and are not monitored after hours, on weekends, or during official CCC holidays. If I believe there is an immediate risk of harm to self or others I will contact 9-1-1 or CCC Campus Safety (503-594-6650).(Required)
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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. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission