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Form to Report Sexual Harassment, Sexual Assault, Dating/Domestic Violence, Stalking, or Sexual Exploitation

The University of Rochester is committed to providing a safe environment to work, learn, live, and socialize together without fear of sexual assault, harassment, or discrimination.

Students, faculty, staff, visitors, and others may use this form to file a report about sexual misconduct, including sexual harassment on the basis of sex, sexual orientation, gender identity or expression.

If you need immediate help

  • Call University Public Safety: (585) 275-3333
  • Dial #413 on campus blue phones
  • Call 911

About This Form

The University of Rochester’s Title IX Coordinator reviews all submitted reports and retains the information in the Title IX Office. Please note that reports submitted using this form will be reviewed during normal business hours. 

If the reporting party/affected party provides their name and contact information, a staff member from the Title IX Office will reach out to that individual and provide resources, support, and information on options and next steps.

If you are a responsible employee (as defined in the Student Sexual Misconduct Policy), you are required to include your name and contact information in this form, and the name(s) of the accused, and other involved individuals you are reporting about.

Please note that Title IX Coordinators and Deputy Coordinators are private, but not confidential resources. They will address your submitted report with sensitivity and keep your information as private as possible.


Anonymous Reporting

If you wish to remain anonymous, you may enter “anonymous” in the name field. While the University takes all reports seriously, our ability to take action on anonymous reports, depending on the information that is shared, will likely be limited or impossible.

In cases of anonymous reports where we are unable to take action, the University will use the information shared for statistical purposes, to better understand the scope of sexual misconduct on campus, and to develop and implement preventive efforts.


Support Services and Resources

Please visit Sexual Misconduct and Title IX for additional information about:

  • Resources and support services
  • Policies and procedures related to sexual misconduct
  • Definitions of key terms
  • Frequently asked questions

Instructions

Please fill out the form below to the best of your ability. As indicated, you may select all options that apply to your situation for certain questions. You are not required to complete the entire form to submit.

If you have trouble accessing or using this form, please contact (585) 275-7814. You may also report the issue using the University’s contact form.

Your Information

All fields marked with a red asterisk (*) are required.