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Title IX Incident Reporting Form

If you need to report an emergency, dial 911. 

 

If you have any questions about the complaint process or need assistance completing this form, please contact the Title IX Coordinator at 720-390-6975 or email [email protected]. 

If you would like to report confidentially, VCA students may contact the Title IX Coordinator at 720-390-6975 or email [email protected]. VCA students and staff can also make a report via Safe2Tell. Safe2Tell, a toll-free, Colorado tip line is available for anyone in Colorado concerned about a threat to student and staff safety. Callers may remain anonymous. The Safe2Tell phone number is 1-877-542-SAFE (1-877-542-7233). VCA students and staff can also report issues or concerns anonymously through the District, via APS SafeNet. 

You may make a report anonymously; however, this may limit the school's ability to investigate the incident or provide resources to the involved parties. For more information on Title IX options and supportive measures, or the school's Title IX policy and procedures, please contact the school's Title IX Coordinator, Keith Shaffer, at 720-390-697 or visit VCA's Title IX website. 

Additional local and national resources are available on VCA's Title IX Compliance webpage. Please review the VCA policy for information regarding the Title IX process, on the board policy webpage. 

Please fill out this form to report instances of sexual harassment, sexual assault, stalking, dating violence, athletics-related complaints, or domestic violence. If you experience difficulties submitting this form, please contact the Title IX Coordinator, Keith Shaffer, at 720-390-6975, or email [email protected]. 

Your Affiliation with VCA (Required) *
Answer Required
Type of Incident (Required) *
Answer Required
Location of Incident (Required) *
Answer Required

Involved Parties

Please list all individuals involved in the incident(s). Please note that if you do not know, or choose not to provide the name of involved individual(s) or group that you are reporting, VCA may be limited in its ability to address the allegations. 

An individual listed as a "Complainant" is an individual who is alleged to be the victim of conduct that could constitute sexual harassment; one listed as a "Respondent" is an individual who has been reported to be the perpetrator of conduct that could constitute sexual harassment; one listed as a "Witness" is an observer to the incident(s) and/or who has personal knowledge of information relevant to this incident report; and one listed as "Third Party or Mandatory Reporter" is a person who is reporting an incident, and/or has a duty to report incidents of sexual harassment as a VCA employee. 

Person #1: Select Role *
Answer Required
What is the relationship(s) of the Respondent(s) to the Complainant(s)?
Answer Required
Please select the departments or agencies that were made aware of the incident(s):
Answer Required
SUPPORTIVE MEASURES: Complainants and Respondents have the right to certain supportive measures that are non-disciplinary, non-punitive individualized services offered as appropriate, as reasonably available, and without a fee or charge before or after the filing of a formal complaint or where no formal complaint has been filed. Supportive measures may include, but are not limited to, availability of counseling, mutual restrictions on contact between the parties, campus escort services, modifications of class or work schedules; extensions of deadlines or other course or work related adjustments, leave of absences or increased security.(Required) *
Answer Required
RETALIATION PROHIBITED: Retaliation for complaints made under the District's Title IX policy, or participation in any investigation either as a Complainant, Respondent or Witness is prohibited, and should be reported to the Office of Title IX immediately. No person may intimidate, threaten, coerce, or discriminate against any individual for the purpose of interfering with any right or privilege, or because an individual has made a report or complaint, testified, assisted or participated or refused to participate in any manner in an investigation, proceeding or hearing.(Required) **
Answer Required
RIGHT TO AN ADVISOR/SUPPORT PERSON: Both parties have a right to be accompanied by one advisor/support person to assist them throughout the Title IX process. “Advisor” means a person chosen by a Party to provide support and advocacy during the Title IX process, and may include, but is not limited to, a parent, legal guardian, or attorney. The advisor/support person is not allowed to speak or otherwise actively participate during the investigative interviews or meetings. It is the responsibility of the parties to obtain the services of an advisor/support person, except that the District will make an advisor available to the parties during the hearing to determine responsibility upon request.(Required) *
Answer Required
Does the Respondent(s) know you are making this report? (Required) *
Answer Required

You have the option to attach any text messages, emails, photos, video or supporting documents. The more documentation you can provide, the more VCA can address your allegation. 

Please upload your supporting documentation here.
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