File a Report with the Title IX Coordinator at NC

Your Name(Required)

First Last

Department or Student ID#

Your Phone(Required)

Your Email(Required)

Date of Incident(Required)

Time of Incident(Required)

Place or Location of Incident(Required)

Name of People Involved(Required)

Name of Witnesses

Details of Events(Required)

Were the police contacted?

Yes

Was a police report issued?

Yes

Was survelliance available?

Yes

CAPTCHA

Name

This field is for validation purposes and should be left unchanged.