Request for Mutual No Contact Order Form

Request for Mutual No Contact Order

This is the Request for Mutual No Contact Order Form to be submitted to be considered by the Title IX Office.

Request for Mutual No Contact Order Form

A party may a Mutual No Contact Order as a supportive measure without proceeding with the formal process. The Mutual No Contact Order will be written as narrow as possible to reduce communication between the parties while not being punitive or disciplinary along with limiting the impact to education programs or activities for either party. A Mutual No Contact Order will have an expiration date. A party may commence the request by submitting their request to the Title IX Coordinator. The Request should set forth: 1) What are the names of the individuals involved in the request, 2) How long are you requesting the Mutual No Contact Order for, 3) What is/are the reason(s) for the request, 4) What fact(s) support the request, and 5) Any specific request involving shared classes, work places, etc. Please be aware that the other party also has the right to ask for an extension, dismissal, or modification of a Mutual No Contact Order as well as appealing the issuance of the Mutual No Contact 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.

Name of Person Requesting Mutual No Contact Order:(Required)

First Last

Email address of Person Requesting Mutual No Contact Order:(Required)

Enter Email Confirm Email

Name of the Individual Against Whom the Mutual No Contact Order is Requested:(Required)

First Last

Duration of the Requested Mutual No Contact Order:(Required)

You must select one.

four (4) months

six (6) months

one (1) year

What are the reasons for the request? Please provide specific, factual details.(Required)

What facts support the request? Please provide specific, factual details. You can note the information was provide above.(Required)

If applicable, are there any specific requests regarding shared classes, workplaces, or similar situations? [Please keep in mind the following examples: Some classes may only have one section, so limiting proximity or group work in those classes may be necessary. If one party works on campus in a position that requires interaction, such as at a register, they may need to engage for service purposes but should avoid further interaction. Additionally, one party may need to be in the same space due to work obligations. Please provide specific, factual details.]

Upload Any Additional Document

Upload your document in .pdf, .doc or .docx format

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

Please provide your digital signature below.(Required)

Complainant First Name Complainant Last Name

Verification of Electronic Signature(Required)

I verify that I am the person signing this Request for Mutual No Contact Order Form and it is my name listed above.

Important Update: Online Reporting Transition

Beginning Oct. 27, 2025:

The Title IX Office will move to an online-only reporting system. This change reflects a growing trend among Title IX offices nationwide and is designed to help us better serve our campus community.

Our goal is to ensure that Title IX reports are reviewed promptly and thoroughly. In-person and phone submissions, while often well-intentioned, can sometimes involve complex concerns that fall outside the scope of Title IX. These conversations, though important, can require significant time and follow-up, which may delay our ability to respond to Title IX matters with the urgency they deserve.

By centralizing reports through our secure online system, we can more efficiently triage concerns, prioritize Title IX cases, and maintain a consistent and equitable response process for all students, faculty, and staff.

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

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