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ASU Mid-South | West Memphis, Arkansas

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Title IX Complaint Form

ASU Mid-South is committed to the prompt resolution of complaints in a manner consistent with the ASU Mid-South Sex Discrimination, Sexual Harassment, and Sexual Misconduct Policy. You do not have to use this form to receive assistance; however, this form will be used so that we can be certain that all necessary steps for a resolution have been completed. This form is to be used for reporting Title IX complaints. Please feel free to attach additional sheets of information if you believe they are necessary. In addition, please provide any documentation in support of your claim.

If you believe you have been sexually assaulted, harassed, or discriminated against by any member of the ASU Mid-South community or while participating in a college-sponsored activity, you are encouraged to bring it to the attention of any of the following – Title IX Compliance Coordinator Jeremy Reece or Lisa Haggard ( lhaggard@asumidsouth.edu ) and/or other College official.

Step 1 of 3

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  • Respondent Information

    (Individual Complaint is Against)
  • Claim Information

  • Max. file size: 128 MB.
  • Who have you contacted for help rearding this claim?

  • MM slash DD slash YYYY
  • MM slash DD slash YYYY

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