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Gender-Based and/or Sexual Misconduct Report


This form allows you to make a report about any type of sex discrimination, including sexual harassment, sexual assault, relationship violence, stalking, and sexual exploitation, that involves a SUNY Brockport student. The following College departments will receive this report: Title IX Compliance and Student Conduct.


You have the right to submit a report anonymously. While the College takes all reports seriously, our ability to take action on anonymous reports, depending on the information that is shared, may be limited. Please know that campus safety is our utmost concern.


For more information about Title IX at The College at Brockport, please visit: www.brockport.edu/titleix

Reporting Person Information

Please provide any information you would like to share. If you provide us with your contact information, we will make it a priority to follow up. This is not required if you wish to remain anonymous.

 
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Ex. Room number

Involved Parties

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Questions About Incident

1. What was the nature of this incident? Please select all that apply
You must make at least one selection.
2. Was the Victim/Survivor using alcohol and/or other drugs at the time of the incident? The victim/survivor will not be penalized for the use of alcohol and/or other drugs, but this information may help us in determining consent. (See the Amnesty Policy below.) Policy for Alcohol and/or Drug Use Amnesty in Sexual Violence Cases: The health and safety of every student at the College at Brockport is of utmost importance. The College recognizes that students who have been drinking and/or using drugs (whether such use is voluntary or involuntary) at the time that violence, including but not limited to, domestic violence, dating violence, stalking, or sexual assault, occurs may be hesitant to report such incidents due to fear of potential consequences for their own conduct. The College strongly encourages students to report incidents of domestic violence, dating violence, stalking, or sexual assault to College officials. A bystander acting in good faith, or a reporting individual acting in good faith, who discloses any incident of domestic violence, dating violence, stalking, or sexual assault to College officials or law enforcement will not be subject to the College’s code of conduct for violations of alcohol and/or drug use policies occurring at or near the time of the commission of the domestic violence, dating violence, stalking, or sexual assault.
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3. If yes, was the victim/survivor pressured to consume or use alcohol and/or other drugs?
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4. Was the accused person using alcohol and/or other drugs at the time of the incident?
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5. Does the victim/survivor desire SUNY Brockport Student Conduct action against the accused and/or criminal legal action? Select all that apply.
You must make at least one selection.
6. What resources has the victim/survivor utilized thus far? Select all that apply:
You must make at least one selection.
7. Are you open to being contacted by a College official?(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