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Title IX Reporting Form

Forms are typically reviewed within 1 business day. Do not use this form to report events an emergency and/or immediate threats to life or property. If you require emergency assistance, please contact Campus Safety at 570-348-6242 or dial 911.

This form may be used to report information to the Marywood University Title IX Coordinator related to an alleged violation of the Marywood University Interim Title IX Policy (applies to Sex Discrimination, Sexual Assault, Dating Violence, Domestic Violence, Stalking, Sexual Exploitation, and Retaliation) by a member of the Marywood community or a visitor to the University.

The Marywood University Interim Title IX Policy prohibits sexual discrimination or sex-based harassment of any kind, including, but not limited to: sexual assault, domestic violence, dating violence, stalking, sexual exploitation, or retaliation (collectively, Prohibited Conduct).

Q: Who can use this reporting form?
A: Anyone.

Q: What happens when I submit this report?
A: The report is delivered to the Marywood University Title IX Coordinator for review. The Title IX Coordinator will assess the harm to individuals as well as any request for confidentiality.

Q: Will the Title IX Coordinator contact me?
A: If you provide your name and your contact information, yes. We will want to acknowledge and follow-up on your report, check-in with you to learn what resources and support you might want or need, and make sure that you have been provided important information about options and next steps.

Q: What does NOT happen when I submit this report?
A: This form does not initiate an adjudication (formal process or decision), under Marywood's Interim Title IX Policy of the alleged behavior. This form provides you with an opportunity to provide the Title IX Coordinator with information related to sex based harassment. The report will initiate a Title IX review. If you are a person who believes they have experienced sexual misconduct by a current Marywood University student, faculty, or staff member, you may, if you choose, file a complaint to initiate an adjudication process. Information about Marywood's Interim Title IX Policy can be found HERE

Q: I am not sure if I should file this report. Can I talk to someone about my questions without providing details about the information I’m considering reporting?
A: Absolutely. The Title IX Coordinator, Dr. Jeff Kegolis, and the Deputy Title IX Coordinators, Director of Human Resources Ms. Kimberly Padden, and Assistant Director of Athletics, Ms. Nicole Malloy would be happy to speak with you to answer all of your questions. You do not need to provide us with information about the report in order to get your questions answered!

Support and Resources are Available:
The University supports persons affected by sex discrimination or sex based harassment. Support is available in many forms and is available regardless of whether you decide to submit a report.

If you are a Marywood University student, please consider contacting:

During Business Hours:

Marywood Title IX Coordinators to Report an Incident

Title IX Coordinator, Dr. Jeff Kegolis - 570-348-6211 x6050
Director of Human Resources, Ms. Kimberly Padden - 570-961-4549
Associate Director of Athletics and Recreation, Deputy Title IX Coordinator - 570-348-6211 x2489

Confidential Resources

Counseling and Student Development Center - 570-348-6245
Campus Ministry - 570-961-4723
Campus Safety - 570-348-6242
Student Health Services - 570-348-6249

Available 24 hours/7 days per week:

Campus Safety - 570-348-6242
Counseling and Student Development Center - 570-348-6245

To reiterate, if you are experiencing an emergency, or if there is imminent risk to your well-being or that of another person,
contact the Marywood University Campus Safety at 570-348-6242 or dial 911.

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Your full name:

Role (faculty/staff/student):

Your phone number:

Your email address:

Email address must be of a valid format.

Your physical address:

Nature of this report(Required):

This field is required.

Learn more

Please provide as much information as possible, including dates, times, and locations.

Date of incident(Required):

This field is required.

Time of incident:

Location of incident(Required):

This field is required.

Specific location:

Involved Parties

Please refer to the following definitions when indicating "Role" of Involved Parties:

Complainant: An individual who is alleged to be the victim of Prohibited Conduct.

Respondent: An individual who has been reported to have engaged in any form of Prohibited
Conduct or an organization that has been reported to have engaged in Community Standards
Sexual Misconduct.

Name or Organization

Select Role

ID Number (if known)

Questions

Incident Description: Please provide as much detailed information as possible about the incident (there is no text limit).(Required) This field is required.

Other Involved Individual(s): Please list all non-students involved in this incident (if possible, please provide Drivers License #, email, or phone number). If you know that an individual is a student at a neighboring institution please include that information as well. This field is required.

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

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