UA Little Rock Title IX Incident Report Form

  • Incident Information:

    Please fill out this form to report instances of sexual harassment, discrimination, or misconduct. If you experience difficulties submitting this form, please contact the Title IX Coordinator at 501-916-5716, or send an email to
  • Date Format: MM slash DD slash YYYY
  • :
  • Offender Information

  • Please enter a number from 0 to 20.
  • Reporter Information

    Thank you for providing this information. Although you may report anonymously, you are encouraged to provide your name and contact information so we can provide you with information about additional resources and processes available to you. We will follow up to the extent possible with information you have provided and any more you choose to provide in the future. Our ability to take remedial action may be limited should you choose to report anonymously.
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