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Full text of the Gender Equity, Sexual Misconduct and Relationship Violence policy and procedure can be found here.

Naropa University is committed to cultivating a university environment free of harassment, discrimination and violence. In accordance with this commitment, the University does not discriminate on the basis of sex, gender or gender identity/expression in its education programs and activities, and Title IX of the Education Amendments of 1972 (Title IX) prohibits the discrimination on the basis of sex in education programs or University activities, regardless of whom is the perpetrator. The University is also committed to protecting victims of opposite and same-sex relationship violence and shall complete impartial investigations addressing instances of relationship violence, including dating violence, domestic violence and stalking, under all circumstances, including when there is a pending criminal investigation or prosecution. You do not have to use this form to receive assistance; however, this form will be used so that we can ensure that all necessary steps for a resolution have been completed.

This form is used to submit a complaint to Naropa University’s Associate Director for Equity Compliance and Title IX Coordinator. Please feel free to attach any additional documentation in support of your claim. Please provide as much information as you are able, and leave blank any sections you are unable to complete. By clicking “Submit”, this form and any attachments will be sent directly to the Associate Director for Equity Compliance and Title IX Coordinator, Sarah Silvas-Bernstein, who will follow up with you as soon as possible.

Naropa University is committed to supporting all students, faculty and staff in the filing of complainants. If you need this form in alternative format, please contact the Associate Director for Equity Compliance and Title IX Coordinator at ssilvas@naropa.edu (mailto:ssilvas@naropa.edu) or 303-245-4843.

THANK YOU!

Sarah K. Silvas-Bernstein

Associate Director for Equity Compliance

Complainant Information (Individual filing the complaint)

  
 

Name:

 
 

Department:

 

Home Phone:

 

Cell Phone:

 

Email:

 

Address:

 

City:

 

State:

 

Zip:

 

How do you prefer to be contacted?

  

Respondent Information (Individual against whom you are filing the complaint)

  
 

Name:

 

Department:

 
 

Home Phone:

 

Cell Phone:

 

Email:

 

Address:

 

City

 

State:

 

Zip:

 

Who have you contacted for assistance or support with this concern?

 

When did the incident(s) first take place?

 

When was the most recent incident(s)?  

 

What is the nature of the complaint (check all that apply)?







 

If Other, please specify:

 

If discrimination, were you discriminated against in regard to your (check all that apply):



 

If discrimination, were you discriminated against because of any of the following (check all that apply):








 

Please provide a detailed statement of the events, including dates, times, and locations. Please attach additional statement(s), if needed, and any documentation in support of your claim.

 

Please provide the names and contact information for any witnesses that can provide material information in support of your claim.

 

What effect has this incident had on you?

 

What other actions, if any, have you taken to try to stop the offensive conduct? (i.e. contacting police, applying for a protection order)

 

What, if any, immediate needs do you have with which you would like university support?

 

Please include any attachments here.

  

 Complaint Acknowledgement

I certify that to the best of my knowledge the information that I have provided is accurate and the events and circumstances are as I have described them. 

I understand and acknowledge that a copy of this complaint, along with any attachments provided, will be furnished to the alleged respondent. I also understand and consent to the disclosure of information contained in this complaint to the appropriate administrators and witnesses interviewed for the purpose of investigating this complaint. 

I understand that the nature of this complaint, correspondence, and all discussions and interviews conducted in the course of the investigation of information provided in this complaint are confidential to the extent permitted by law and unauthorized disclosures of information concerning the investigation could result in disciplinary action. I agree to abide by these guidelines. 

I understand that the investigation of a complaint under the Gender Equity, Sexual Misconduct and Relationship Violence Policy (“Policy”) and Procedures will be concluded as soon as possible after receipt of this written complaint. Complainants are advised that Naropa University has 60 days to resolve any complaint received under this Policy. Upon completion of the investigation, the Title IX office will prepare a written report of findings and submit the report to the proper administrator. The complainant and respondent will be notified in writing of the findings, outcome and any sanctions imposed. Reports, outcomes and all evidence submitted are subject to become part of the individual(s) record. 

I understand that the course of action taken by Naropa University to resolve this complaint is determined by the Title IX Coordinator in accordance the Policy. Complainants will be notified of any actions taken by the University in response to complaints filed. 

I understand that I reserve the right to seek other remedies as described within the Policy.

 

Print Name:

 

Date: