Jump to Header
Jump to Main Content
Jump to Footer
Return to home
Open Menu
Open Search
Search
Search
Close Search
Admission
Click to toggle child links
Undergraduate Admission
Graduate Admission
Seminary Admission
Academics
Click to toggle child links
Undergraduate Programs
Graduate & Doctoral Programs
Seminary Programs
Student Success & Academic Support
Research & Scholarship
Study Abroad & International Education
Internships & Careers
Centers & Institutes
Registrar
Library
Financial Aid & Costs
Click to toggle child links
College Affordability
Undergraduate Cost & Aid
Graduate Cost & Aid
Seminary Cost & Aid
Paying Your Bill
Financial Aid Staff
Student Life
Click to toggle child links
Activities & Organizations
Athletics
Diversity, Equity & Inclusion
Health & Wellness
Residence Life
Leadership & Service
LR Experience
Religious & Spiritual Life
Campus Safety
Campuses
Click to toggle child links
Asheville Campus
Columbia Campus
Hickory Campus
LTSS (Seminary)
Online
About
Click to toggle child links
Fast Facts
History & Traditions
University Leadership
Strategic Plan
Accreditation
Directory
Offices & Services
Community Partners
Quick Links
Students
Faculty & Staff
Parents
Athletics
Alumni
Give
Close Menu
Submit a Sex/Gender Discrimination, Harassment, Misconduct and/or Retaliation Report
For additional resources, or if you have questions, contact Avery Staley, Title IX Coordinator, at
avery.staley@lr.edu
or
TitleIXCoordinator@lr.edu
or 828.328.7443.
If you would like to make an anonymous complaint, you may complete this form with all details of the incident except your name and other identifying information. However, if you make an anonymous report, it will limit the university’s ability to respond. If you aren’t sure whether you want to report your name, we encourage you to talk through your options with a confidential resource, including a university counselor, pastor or student health provider.
Date of Report
Reporter Name
Phone Number
Email
Faculty
Staff
Student
Other
Is the Reporter
Does the complainant wish to remain confidential at this time?
(The complainant only wants their name and information about the incident to be shared with the Title IX Coordinator.)
Yes
No
Date and Time of Incident: Date
Date and Time of Incident: Time
Date and Time of Incident
Location of Incident
Please provide as much information about the incident as possible
Alleged individual against whom the grievance is asserted ("respondent")
Fist and Last Name
Gender
Phone Number
Email
Does the respondent live on-campus or off-campus
On-campus
Off-campus
Was the respondent known to the complainant prior to the incident?
Yes
No
Potential witnesses to the incident
Name and Contact Information (Phone, Email)
Name and Contact Information (Phone, Email)
Name and Contact Information (Phone, Email)
Does the complainant wish to notify law enforcement at this time?
Yes
No
If law enforcement was already notified, which agency was notified (check all applicable)?
LRU Security
Hickory Police Department
Other
Submit
Leave this field blank