Title IX Incident Report

This reporting tool is for non-emergency incidents and non-emergency Clery Act crime reports only. For emergencies, including safety concerns, call the Office of Campus Safety at (607) 735-1777 or dial 911. For any health related concerns, contact the Clarke Health Center at (607) 735-1750.

Contact Information

If you are an employee of Elmira College, you must provide your contact information below. If you are a victim of a crime or are self-reporting an incident, you may choose to submit anonymously.

Reporting Type: *
First Name:
Last Name:
Your Affiliation with the College: *

Incident Time and Location

Date you became aware of the incident: *
Approximate time you became aware of the incident: *

Date the incident occurred: *
Approximate time the incident occurred: *

Where did the incident take place (check all that apply)? *


Location (building name, address, street name):

Incident Reporting Details

Please check the box(es) that best describe the incident you are reporting: *




















If 'Other/Unknown', please describe:
If you believe the victim(s) was/were targeted specifically because of discrimination—including bias-related harassment, hazing, intimidation, bullying, sexual misconduct, domestic violence, dating violence and/or stalking—please check the box(es) that best describe the basis of discrimination: *














If 'Other/Unknown', please describe:

Incident Description

Please provide a description/explanation of the reported incident, or attach a written narrative before you submit.

What happened? Who was involved? If known, provide the names or descriptions of suspects, victims, and witnesses.
Please attach any additional documents if needed:
Phone Number:
Email Address:
Electronic Signature: I understand this is a legal representation of my signature.