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Sexual Misconduct and Clery Reporting Form


Background Information

Includes sexual harassment, sexual assault, non-consensual sexual intercourse, non-consensual sexual contact, sexual exploitation, sexual exposure, relationship violence, dating violence, domestic violence and stalking. Once this report is submitted, a member or members of the Sexual Misconduct Response Team will make an initial assessment and will respond accordingly. If you wish to submit this form anonymously, please do not include your contact information.


The following definitions will assist you in completing this report:

Complainant: is a person who experiences the alleged sexual misconduct.

Reporting Party: is an individual, i.e., complainant, member of Millersville community or visitor who makes an allegation that sexual misconduct has occurred.

Respondent: is the individual against whom allegations of sexual misconduct or retaliation are made.



If you are reporting an incident that involves an employee please select sexual misconduct involving an employee .

This Reporting Form is NOT a 911 or Emergency Service:
Do not use this site to report events that present an immediate threat of life or property. Reports that are submitted through this form may not receive an immediate response. If this is an emergency, please contact the Millersville University Police at 717-871-4357 or dial 911.

This report may be used for Clery reporting.

 
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If you would like to remain anonymous, please do not fill in your contact information.
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If you would like to remain anonymous, please do not fill in your contact information.
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If you would like to remain anonymous, please do not fill in your contact information.
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If you would like to remain anonymous, please do not fill in your contact information.
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If you would like to remain anonymous, please do not fill in your contact information.
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Please select sexual misconduct involving an employee if an employee is involved.
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Choose the most specific answer.
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Exact address of incident location if known.

Involved Parties

Please fill in as much information as you can for each person.

Involved party 1

Questions

This field is required.
Please select the role of the complainant in this case. The complainant is a person who experiences the alleged sexual misconduct.(Required)
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Please select the role of the respondent person in this case. The respondent is the individual against whom allegations of sexual misconduct or retaliation are made.(Required)
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Was this a random attack or an acquaintance?(Required)
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This field is required.
This field is required.
Do you know if the respondent has done this to the complainant or someone else before?(Required)
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Is the complainant concerned about their safety?(Required)
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Does the complainant have any concerns about the safety of other students on campus as a result of this incident?(Required)
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Would the complainant like any police assistance in resolving this incident?(Required)
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Would the complainant like the University to initiate a Title IX investigation?(Required)
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Does the complainant wish to have class schedule or housing rearranged?(Required)
You must make at least one selection.
You are making this report(Required)
You must make at least one selection.

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