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Discrimination, Harassment, and Retaliation Reporting Form


This form provides preliminary information to the Title IX Services or Human Resources units of Texas Lutheran University's Office of Diversity, Equity, and Inclusion to assist in resolving violations of TLU's Civil Rights Equity Resolution Policy and Procedures for All Employees and Students, Student Code of Conduct, Employee Rules of Conduct, and Faculty Bylaws and Manual . Please complete this form to the best of your knowledge.

This form is appropriate for reporting claims of discrimination or harassment based upon race, color, religion, sex/gender (including pregnancy and parenting responsibilities, sexual orientation, or gender identity), national origin, age, disability, genetic information (including family medical history), or any other protected class listed in Section 15 ("Policy on Nondiscrimination") of the Civil Rights Equity Resolution Policy and Procedures for All Employees and Students. This includes Title IX-related discrimination or harassment (including sexual assault, dating violence, domestic violence, stalking, or sexual harassment).

It is also the appropriate form for reporting claims of retaliation (punishment) for filing a charge or complaint of discrimination or harassment, participating in a discrimination or harassment investigation or lawsuit, or opposing discrimination or harassment.

Upon receipt of this form, someone from the Office of Diversity, Equity, and Inclusion may contact you if additional information is needed.

Regardless of the nature of your report, Texas Lutheran University will ensure that your information is forwarded to the office with responsibility for investigating and addressing complaints, reports, or concerns as appropriate, based on the information you have provided.

The information you provide will be kept confidential or private to the extent permitted by law.

If you have questions, please contact our office at titleix@tlu.edu or by phone at 830-372-6349.

This Reporting Form is NOT a 911 or Emergency Service. Do not use this site to report events presenting an immediate threat to life or property. If you require emergency assistance, please contact TLU Police at 830-372-8000 or dial 911.

Reporter Information

NOTE: If you wish to submit a complaint anonymously and you are not a Responsible Employee or Mandatory Reporter (all TLU employees are mandatory reporters for Title IX/sex and gender discrimination reports*), you may omit your contact information below. Alternately, you may also call the Campus Conduct Hotline (available 24/7) at 866-943-5787 or send your complaint to:



Office of Diversity, Equity, and Inclusion

Beck Center, Suite 104

Texas Lutheran University

1000 W. Court St.

Seguin, TX 78155



* NOTE: Exceptions to Mandatory Employee reporting include if the employee is the complainant/victim/survivor themselves or if the information is learned through a Community Awareness event (such as "Take Back the Night").

 
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Name of person completing this report. See above for anonymous reporting info.
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Student, Faculty, Staff, Alumni, Parent, Visitor, etc
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Preferred phone number
Email address must be of a valid format.
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TLU email address is preferred, if you have one
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On-Campus location (Rm. 100, Beck Center) is okay
This field is required.
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Select the option which seems most appropriate to you.
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Estimated date of Incident. If unknown, choose today's date..
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Complete if known. Please indicate a.m. or p.m.
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Select
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Complete if off-campus, online (social media, email, text, etc.), elsewhere on-campus, or other.

Involved Parties

Please provide the requested information about the individual (or individuals) you believe discriminated against, harassed, or retaliated against another individual (or individuals). This would include alleged incidents of sexual harassment, sexual violence, relationship violence, and stalking.

If you are completing this as a Responsible Employee or Mandatory Reporter (all TLU employees are mandatory reporters for Title IX/sex and gender discrimination reports), please indicate all involved parties of which you are aware, their respective roles, and all other information you possess regarding the allegation. Click on the "add another party" button until you have added all known involved parties. If you do not have the information requested, you may leave fields blank.



Related Terms

Complainant: An individual alleged to have experienced harm by (or identifies as a victim or survivor of) conduct prohibited by University policy.

Respondent: An individual alleged to have committed an act or acts of conduct prohibited by University policy.

Witness or Third-Party: An individual who may not have directly experienced prohibited conduct under University policy, but may have knowledge of prohibited conduct, either through direct observation, general awareness of an event, or information disclosed by one of the involved parties.

Involved party 1

Incident Specific Information

Please complete the information below to the best of your ability.

Are you reporting this incident for yourself or for another person?(Required)
This field is required.
What is the nature of this report? (please select all that apply)(Required)
You must make at least one selection.
Do you feel this behavior happened because of: (please select all that apply)(Required)
You must make at least one selection.
This field is required.
This field is required.
This field is required.
Please select one of the following: (All TLU employees are mandatory reporters for Title IX or sex and gender discrimination reports.)(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.

Submission