Sexual Misconduct Complaint Form

Background Information

Your full name:

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Or, you may write Anonymous

Your position/title:

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If Not Applicable - Leave Blank

Your phone number:

Your email address:

Email address must be of a valid format.

Your physical address:

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.

Time of incident:

Location of incident(Required):

This field is required.

Location of incident:

Involved Parties

Please list the individuals involved (excluding yourself), including as many of the listed fields as you can provide. For students, faculty and staff members, please enter the MUW ID number. For non-students, please list an SSN or Drivers License number in the block labeled SID if available.

Name or Organization

Select Gender

Select Role

ID Number

DOB (YYYY-MM-DD)

Phone number

Email address

Hall/Address

Description/Narrative

Please provide a detailed description of the incident/concern using specific concise, objective language.

Were there any witnesses to the alleged sexual misconduct? This field is required.

If yes, please provide witness names, contact numbers and email addresses, if known. This field is required.

Have efforts been made to resolve this complaint? This field is required.

What would you like to see happen? This field is required.

If the person preparing this complaint is not the victim, but is assisting the victim, please provide the following information: Name and Relationship to Victim This field is required.

Please provide a detailed description of the incident/concern using specific concise, objective language.(Required) This field is required.

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. Maximum 12 megabytes per file. Attachments require time to upload, please be patient after you click to submit this report. 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

Description/Narrative

Supporting Documentation

Submission