Report Form for Sexual Misconduct, Dating/Relationship Violence, Stalking

Background Information

If you are reporting on behalf of someone else, record your information below and record their name and contact information. You may submit this form anonymously. If you wish to identify yourself, please fill in the information listed below.

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Your Full Name:

Your Position/Title:

Your Phone Number:

Your Email Address:

Email address must be of a valid format.

Nature of this Report(Required):

This field is required.

Urgency of this Report(Required):

This field is required.

Date of Incident(Required):

This field is required.

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If exact date is not known, best estimate is okay.

Time of Incident:

Location of Incident(Required):

This field is required.

Specific Location:

Involved Parties

Please list all parties involved (excluding yourself) and provide as much information as possible in the demographics fields. If you do not have access to the demographic information, please continue to submit the report; the information will be researched once the report is received.

Roles in which the parties may be involved include the following:

Respondent: accused member of the University or Community who may have violated University policy;

Complainant: individual who allegedly experienced Sexual Misconduct while a student or University employee;

Witness: individual (excluding yourself) who observed the alleged behavior and can provide additional information;

Name or Organization

Select Gender

Select Role

ID Number

DOB (YYYY-MM-DD)

Phone Number

Email Address

Residence Hall/Local Address

Description

Describe, in as much detail as possible, the specific behaviors observed, including words, phrases, actions, dates and times. If the information was provided to you through a third party, provide as much detail as you can about the incident. If the involved party used profanity, made threats, or spoke of harming self or others, indicate specific words and phrases used. Please describe any injury or damage to individuals or property. Include names of University personnel you contacted and actions taken, if any.

The following information is needed to understand what occurred in order to respond appropriately. Information must be truthful; any individual knowingly providing false information may be subject to disciplinary sanctions and legal action. Complaints that are later found not to violate policy are not assumed to be false.

Please provide as much factual detail as possible (who, what, where, when, how it happened).(Required) This field is required.

Select any of the following that apply:

St. Cloud Police Involved Public Safety Arrested/Booked Medical Response None

You must make at least one selection.

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 1GB maximum total size.

Attachments require time to upload, so please be patient after submitting form.

5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Background Information

Involved Parties

Description

Supporting Documentation

Submission