Sexual Harassment Anonymous Report Form

Your Contact Information

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Your full name:

Your phone number:

Your email address:

Email address must be of a valid format.

Description of Incident(s)(Required):

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Urgency of this report(Required):

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Date of Most Recent Incident(Required):

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Time of incident:

Location of incident(Required):

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Specific location:

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Please be as specific as possible.

Involved Parties

Please enter information you have about any people involved in the incident(s), including the accused, reporter, victim/survivors and witnesses.

Name or Organization

Select Gender

Select Role

Phone number

Email address

Hall/Address

Incident Information

Please explain the incident(s) in as much details as is known.(Required) This field is required.

What is your relationship to the victim/survivor?(Required) This field is required.

What is your affiliation with Trinity College?(Required) This field is required.

What is the accused's relationship to the victim/survivor?(Required) This field is required.

What is the accused's affiliation with Trinity College?(Required) This field is required.

Were drugs or alcohol involved in the incident(s)?(Required)

No Yes Unknown

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Does the victim/survivor report feeling drugged?(Required)

No Yes

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To which services do you refer the victim/survivor/reporting party?(Required) This field is required.

Supporting Documentation

Please attach any additional documentation you would like to include in the report. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Your Contact Information

Involved Parties

Incident Information

Supporting Documentation

Submission