Marymount University Logo

Sexual and Interpersonal Misconduct Reporting Form


This is not a police report.

Please note submissions to this form may not be reviewed outside of normal business hours. If this is an EMERGENCY situation, call 911 and then contact Marymount University's Campus Safety Office at 703-284-1600. Do NOT use this form to report events that present an immediate threat to health or safety. The Title IX Coordinator will review each report within 24-48 hours. 

Submitting this report notifies the following entities within Marymount University: Kaylee Chappell, Title IX Coordinator & Assistant Director for Community Standards

This form is intended for reports of sexual or interpersonal misconduct, including (but not limited to) sexual assault, non-consensual sexual contact, interpersonal violence (relationship violence), stalking, sexual harassment, sexual exploitation, complicity, and/or retaliation.

Reports that contain minimal, incomplete, or false information may limit the University’s ability to respond. In order to ensure the University’s ability to respond to this report, please fill out as much information as possible with as much detail as possible. If you have questions about making a report of sexual or interpersonal misconduct to the University’s Title IX Office, please contact us by phone at 703-526-6940 or email at titleix@marymount.edu. You may also visit the Marymount University Title IX website here. 

Although the Title IX Coordinator will take reasonable steps to address reports of misconduct while keeping confidential the identity of the reporter, there may be instances where the Title IX Coordinator must disclose the reporters name on a need-to-know basis in order to resolve the report. The University must also consider its obligation to maintain a safe environment for the Marymount University community. Please note that this form can be filled out anonymously (unless you are a Mandated Reporter submitting information about an incident that was disclosed to you), but choosing to make an anonymous report can significantly limit the ability of the University to respond. 

  • This report does not automatically initiate a Title IX Investigation. It provides you with an opportunity to inform the Title IX Coordinator of your experience and to receive supportive measures and information about your reporting options.
  • To access confidential support options reporting parties may contact any of the following: Student Counseling Services - (703) 526-6861; Student Health Services - (703) 284-1610; or Father Gabriel Muteru - gmuteru@marymount.edu.
  • If you choose to file a formal complaint, the information provided on this report may be used to form the initial basis of your complaint.
  • Amnesty for Personal Use of Alcohol or Drugs: The University seeks to remove any barriers to reporting an act of sexual misconduct. The University will generally offer any student, whether to Complainant or a witness or a third party, who reports sexual misconduct, limited immunity from being charged for Policy violations related to the personal ingestion of alcohol or drugs, provided that any such violations did not, and do not, place the health and safety of any person at risk.

Reporter Information

While anonymous reports are accepted, you are strongly encouraged to provide your name and contact information in order to allow us to most effectively address the concerning behavior. If you choose to remain anonymous, we may be limited in our response. 

Mandatory Reporters may not submit an anonymous report. If you are classified as a Mandatory Reporter, please fill out all information.

 
Enable additional features by logging in.
Email address must be of a valid format.
This field is required.
This field is required.
This field is required.

Involved Parties

Please provide as much information as possible for all involved parties.

Note: If you are an involved party to the report (Complainant, Respondent, Witness), please also include yourself below. A Complainant is the person who experienced the alleged sexual or interpersonal misconduct. A Respondent is the person being reported for a potential Sexual or Interpersonal Misconduct Policy violation(s). A Witness is a person who saw or heard an incident occur or who has relevant information about it

Involved party 1

Questions

Please provide as much detail, including names, dates, times, and locations in the questions below. You will also be able to provide documentation below if there are text messages, social media messages, screenshots, or other documentation. While providing details is essential to investigate your complaint, please be advised that some or all of the information you provide in this section may be shared with the person(s) you are accusing. You may supplement this description later if you wish to share additional details.

This field is required.
This field is required.
This field is required.

Supporting Documentation

Please add any additional documents that support your complaint. 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