Title IX: Sexual Harassment, Discrimination, and Assault Report

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


Your Information
Respondent Information
Against Whom Are You Making a Complaint?
Incident Information
Please describe in detail. Include a full description of all events, including verbal statements made and any physical contact if physical contact was involved. If Respondent’s behavior has been repetitious, please describe multiple incidents in this section.
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.