Request for Extension, Dismissal, or Modification of Mutual No Contact Order Form

Request for Extension, Dismissal, or Modification of Mutual No Contact Order

This is the Request for Extension, Dismissal, or Modification of Mutual No Contact Order Form to be submitted to be considered by the Title IX Office.

Request for Extension, Dismissal, or Modification of Mutual No Contact Order

Instructions for filling out this form: Both Parties may request an extension, a dismissal, or a modification of a Mutual No Contact Order. A party may commence the request by submitting their request to the Title IX Coordinator. The Request should set forth: · What specific Mutual No Contact Order is involved in the request, · Whether the request is for an extension, a dismissal, or a modification of a Mutual No Contact Order, · What is/are the reason(s) for the request, · What fact(s) support the request, and · If applicable, what modification(s) is/are being requested? Please be aware that the other party also has the right to ask for extension, dismissal, or modification of this Order. Additionally, the determination of this request is not subject to the same grievance process as making a determination regarding responsibility under the Title IX policy. Parties are not required to file a request.

Name of Party Completing Form(Required)

First Last

Email address of Party Completing Form(Required)

Enter Email Confirm Email

Address of Party Completing Form(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Telephone number of Party Completing Form(Required)

Name of Parties on Mutual No Contact Order(Required)

Date of Mutual No Contact Order(Required)

This Request involves:(Required)

Extension of Mutual No Contact Order

Dismissal of Mutual No Contact Order

Modification of Mutual No Contact Order

Please provide the specific reasons for your request, including factual details. If you prefer, you can upload a document below with this information and indicate that you are uploading it.(Required)

What specific facts support your request? Please provide detailed, factual information.

If applicable, what modifications are being requested? Please provide specific details.

Upload Any Additional Document

Upload your document in .pdf, .doc or .docx format. To upload, click on "Choose File" to access your documents and choose the file you wish to upload. "Choose File" may not appear to be a link, but it is.

Accepted file types: pdf, doc, docx, Max. file size: 25 MB.

Please provide your digital signature below.(Required)

First Name of Party Completing Form Last Name of Party Completing Form

Verification of Electronic Signature(Required)

I verify that I am the person signing this Request for Extension, Dismissal, or Modification of Mutual No Contact Order Form.

If you have any questions or concerns about this process, please email Marshall’s Title IX Coordinator at titleix@marshall.edu.

Important Reminder: Online Reporting Strongly Preferred

Title IX Reporting - Online Submissions PREFERRED:

The Title IX Office prefers the submission of Title IX report through the online reporting system. It is preferred that all Title IX reports be submitted through our secure online form. This centralized process helps us review reports promptly, triage concerns efficiently, and ensure consistent and equitable responses for our campus community.

In‑person, email, and phone submissions are accepted on a limited basis as reporting methods for Title IX incidents. Those conversations may still occur for support purposes, but they do not constitute an official Title IX report.

Submit an Online Title IX Report

Please note: Due to staff availability, it may take up to five business days for your report to be reviewed.

If You Are in Crisis

Call 911 or contact the Marshall University Counseling Center for immediate support:
Prichard Hall, First Floor
304-696-3111
Marshall University Counseling

We appreciate your understanding and remain committed to supporting a safe, respectful, and inclusive campus environment.