Title IX: Sexual Harassment, Discrimination, and Assault Witness Report

**If there is an immediate threat to your safety or the safety of another, call 911, the Ada Police Department at (419) 634-0010 or Campus Security at (419) 772-2222.**

 

Witness Information
Victim/Survivor Information
Accused (Respondent) Information
Incident Information
Please indicate if you witnessed the incident, were informed of the incident by the victim, or were informed of the incident by a third party.
Describe the incident in as much detail as possible. Please include a full description of all events known to you, including names of the parties involved, verbal statements made, and physical contact if physical contact was involved.
Please list all of the witnesses to the incident. For each, include his or her name, status (student, faculty, staff or other) and email address.