Sexual Misconduct Incident Report

Background Information

If you wish to identify yourself, please fill in the information listed below.

If the person completing this form is the victim, you may choose to identify yourself or not. If you are a third party complainant who is not the victim, include the victim. *You are not obligated to provide your name, but if you choose to remain anonymous that may limit the College's ability to investigate the incident.

Your full name:

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*Or, you may write Anonymous

Title/Position/ID number:

Your phone number:

Your email address:

Email address must be of a valid format.

Your physical address:

Nature of Report(Required):

This field is required.

Urgency of this report(Required):

This field is required.

Date of incident(Required):

This field is required.

Time of incident:

Location of incident(Required):

This field is required.

Specific location:

Involved Parties

Please identify the person(s) whom the complaint is made against.

Name

Gender

Role

ID Number

DOB (YYYY-MM-DD)

Phone number

Email address

Address

Narrative/Description

While providing details is essential to investigating your complaint, please be advised that some or all of the information you provide in this section may be shared with the person(s) you are accusing. You may supplement this description later if you wish to share additional details.

Please provide a brief description of the alleged Sexual Misconduct, including date, times, locations, and any potential witnesses to the behavior. You may wish to consider including, among other things, some or all the following information in your description: the gender of the parties, the relationship between the parties, whether one or more of the parties were under the influence of alcohol or drugs at the time of the alleged misconduct, whether the Respondent used pressure or force (physical or otherwise) in the course of the alleged misconduct, and the frequency (if applicable) of the alleged misconduct.(Required) This field is required.

Please add any additional information that you feel we need to know. This field is required.

Supporting Documentation

Please add any additional documents that support your complaint. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Email me a copy of this report

Background Information

Involved Parties

Narrative/Description

Supporting Documentation

Submission