Title IX Reporting Form File a Report with the Title IX Coordinator at NC If you are a human and are seeing this field, please leave it blank. Fields marked with a * are required. Your Full Name * Department or Student ID# Your Telephone Number * Email Address to Contact You * Date/Time and Place of Incident * Names of People Involved * Names of Witnesses Details of Events * Were the police contacted? Yes No Was there a police report issued? Yes No Police Report # Was video surveillance available? Yes No
