Sexual Misconduct Report Form V2

REPORTING SEXUAL MISCONDUCT

The following form can be used to report sexual misconduct to the Title IX Coordinator. This report can be completed anonymously. Depending on the information included in the report, anonymous submissions may limit the College’s ability to take action. In cases where the information included in sufficient, anonymous reports may be included in Clery Act reporting. Threats to our community are taken seriously and each report will be reviewed by the Title IX Coordinator. Please note that submitting this form does not constitute filing of a formal complaint.

Name:

Email, if you wish to be contacted for further information:

example@example.com

Date of Incident:*

MonthDayYearHourMinutesAM/PM Option

Location(s) the incident occurred:*

Is the person completing this form a:*

Victim/ComplainantWitnessOther

Please Specify:

How many people were involved in this incident:*

Do you know or believe you know the person(s) responsible for the incident?*

YesNo

Please Specify:

What is your relationship with the person(s) involved in the incident?

Please describe what happened in as much detail as possible. Include times, location, number of witnesses and why you believe this incident was motivated by bias:*

Please upload any digital evidence relevant to the report:

Browse Files

(i.e. screenshot, picture, email)