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Title IX Incident Report Form

Instructions: Please complete the following online form to the best of your ability. Report only one incident per form. Please submit this form to the Title IX Coordinator within 24 hours of becoming aware of any incident. Or if you would rather fill out a paper form you may do so using this form and submit it to TitleIX@nashotah.edu.

Nashotah House Theological Seminary requires that all faculty and staff report issues of sexual violence, discrimination, and sexual misconduct to the Title IX Coordinator, Deputy Coordinator, or to the Delafield Police Department.

If you are reporting an incident on behalf of someone else, whenever possible, please be sure the person disclosing information to you understands that this form is NOT CONFIDENTIAL, and if you are faculty or staff that you are obligated to report this information to Nashotah House officials. If the individual does not know that you are reporting his incident, please indicate this in the area below.

If you have any questions, please contact:

Fr. Jason Terhune
Title IX Coordinator
262-646-6518
TitleIX@nashotah.edu
jterhune@nashotah.edu

Incident Report Form

Title IX Incident Report Form

Step 1 of 4

Your Full Name(Required)
Your Physical Address