Title IX Complaint Form

To file a complaint with the University, please complete this on-line form which will be submitted electronically to the Title IX Coordinator. You do not have to complete all of the questions but we ask you answer them to the best of your ability. You can also call the Title IX Coordinator’s Office to make arrangements for a representative to meet with you there or at another location. If you are unable for any reason to complete this form and would like to make a verbal complaint, please call the Title IX Coordinator’s Office to schedule an appointment.

Although the University cannot commit to keeping a complaint or report of sexual misconduct confidential because of the University’s obligation to investigate the complaint or report, the University will use its best efforts not to disseminate information concerning the complaint beyond those who have a need to know. Please feel free to contact our office if you have any questions regarding the process for filing or investigating complaints of sexual misconduct.

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Kirby Klappenback

Director of Risk Management, Title IX Coordinator

402-643-7192 kirby.klappenback@cune.edu Weller Hall 106
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Connie Butler

Director of Human Resources

Human Resources
402-643-7332 connie.butler@cune.edu Weller Hall 102

A victim of sexual misconduct is encouraged to use the University’s internal complaint process.

When the form has been completed and signed your complaint or report has been properly received and noted by the University. We will provide you with a copy of this form as well as complete information about the sexual misconduct complaint process.

Title IX Complaint Form

Required
Required

Witnesses

(Name, Relationship to You, and Phone Number)

First Witness

Second Witness

Third Witness

Signature