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Sexual Misconduct: Request for Support & Assistance


***This report will only be checked during regular business hours. If this is an immediate emergency, please contact University Police at
912-478-5234 (Statesboro Campus), 912-344-3333 (Armstrong & Liberty Campuses), or dial 911.***

This form is intended for individuals to report concerns about sexual misconduct.

Sexual misconduct includes, but is not limited to, non-consensual sexual contact, non-consensual sexual penetration, dating violence, domestic violence, sexual harassment, stalking, and sexual exploitation.

This form allows for anonymous reporting, however, please know that it may be more difficult for the institution to respond and take action upon anonymous reports. Employees who are considered Responsible Employees cannot report anonymously and must include all information known to them.

Note: To file a report regarding discrimination or harassment on the basis of a protected class, please do so here: Discrimination & Harassment Reporting Form.

 

Please provide detailed information regarding the incident you are reporting and indicate the correct Campus Location, Date of Incident, and Location of Incident.

Background Information

 
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This is the date the incident occurred, not the date it was reported.
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Involved Parties

Please list the individuals involved (excluding yourself), including as many of the listed fields as you can provide. For non-students, no ID number is needed.

When selecting the "Role" for each individual you include below, please refer to the following definitions:

  • Complainant/Impacted Party: The individual who may have experienced unwelcome conduct;
  • Respondent/Accused: The individual or organization who is accused of unwelcome conduct;
  • Witness: An individual who has information about the reported situation, or the persons involved in it.
Involved party 1

Questions

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Was a weapon used?
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Were alcohol or other drugs used by the victim?
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Were alcohol or other drugs used by the perpetrator?
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Was the victim injured?
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Was this incident reported to the Police?
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Did the victim utilize or request counseling services?
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Did the victim seek medical attention?
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In accordance with data privacy policies, I understand I may be submitting personally identifiable information on this form.(Required)
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Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission