Report of Sexual Harassment, Sexual Assault, Dating/Domestic Violence, or Stalking

Background Information

You may submit this report anonymously if you do not wish to provide a name or other identifying information at this time. However, the nature of anonymous reports makes responsive action more difficult and, at times, impossible. The nature of the report, the date, and location of the incident are the minimum required information for federal reporting purposes. If you wish to receive a copy of this report for your records, you must provide an email address below.

Your full name:

Your phone number:

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Please provide either a phone number or an email address if you wish to receive support/options.

Your email address:

Email address must be of a valid format.

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Please provide if you wish to receive support/options, and/or to receive a copy of this report.

Nature of this report(Required):

This field is required.

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Please select the primary concern if more than one apply.

Date of incident.(Required):

This field is required.

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If you are unsure of the specific date, please provide an approximate date.

Time of incident:

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If you are unsure, please provide an approximate time.

Location of incident(Required):

This field is required.

Specific location:

Involved Parties

Please list the individuals involved (including yourself), providing as much information as you are willing and able to share. You are not required to provide the names of the individuals involved, but if names are not included it limits the University's ability to take responsive action. Filing an anonymous report ensures that information is recorded in the event the survivor decides to file a complaint at a later date, and also assists the university in compiling accurate crime statistics.

Note: A "Bystander" is an individual who witnesses or learns of an incident, but is not directly impacted as a victim or survivor of this incident.

Name or Organization

Select Gender

Select Role

Narrative of the incident

Please provide a narrative description of the incident/concern you wish to report. You may provide as much or as little information as you choose. Making a report may help with recovery, and this report can serve as a timely record in the event that the survivor chooses to file a complaint at a later date. If you provided your email address above, a copy of this report will be sent to you for your records. This field is required.

Was medical treatment sought relating to this incident? This field is required.

What is your desired outcome as a result of filing this report? (Some outcomes may require a non-anonynmous report.) This field is required.

Supporting Documentation

If you have supporting documentation that you would like to include with your submission, please attach it here. This may include any or all of the following: Photos, video, email, and other supporting documents. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Email me a copy of this report

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