Title IX Sexual Harassment Formal Complaint Form

This form initiates the formal complaint process and may only be completed by a Complainant (person individually harmed by an alleged violation of the Title IX Sexual Harassment Policy).  Complainants may print this form, complete it digitally, or submit their own form.  Forms must contain contact information for the Complainant, provide a location where the violation occurred, the date of when the violation occurred, and be signed (either digitally or manually) by the Complainant.  Forms may be submitted by email to the Title IX Coordinator at arose@uca.edu or by mail to Adam Rose, Title IX Coordinator, Suite 207, Wingo Hall, 201 Donaghey Ave., Conway, AR 72035.


Formal Complaint Form