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Sexual Misconduct

Reporting an incident


Sex-based Incident Proxy Report

This report will be submitted to the University's Title IX Coordinator.

You may complete the online form below or download a printed form

Yes
No

If the assault occurred on campus, indicate where: residence hall
fraternity
work area
other campus building
outdoors
automobile

Describe assault (check all that apply):
  • Sexual contact: (fondling, kissing, petting but not penetration) without consent
  • attempted intercourse without consent (penetration did not occur)
  • intercourse (oral, anal, vaginal penetration by penis or other object) without consent
  • stalking stalking
    • (in the context of a domestic relationship, dating relationship)

Was the absence of consent due to the victim being incapacitated by:

  • alcohol? yes no
  • other suspected drugs? yes no


Describe the kind of pressure or force used by assailant(s) (check all that apply):
  • verbal pressure or arguments
  • position of authority (boss, teacher, supervisor, etc.)
  • threat of physical force (hit, held victim down, twisted arm, etc.)
  • gave victim alcohol or drugs so victim was significantly incapacitated
  • none

Yes
No

Describe the assailant:

If a single assailant, describe:


Role of assailant on campus (select one):
student
faculty
staff
other
no campus role
unknown

If single assailant, describe the nature of the relationship to the victim in the incident (select one):
stranger
spontaneous date (met at a party, or a bar, etc.)
planned-first-date
friend or nonromantic acquaintance of any age
romantic acquaintance or on-going date
relative
unknown


Did assailant(s) appear to use alcohol or drugs:

  • alcohol? yes no
  • other suspected drugs? yes no

Other departments or agencies to which the victim reported this incident (check all that apply):Title IX Coordinator
Residential Life
University Counseling Center
Office of the Dean of Students
University Health Service (UHS)
University Public Safety
Law Enforcement Agency:
Other community resource:
Other University resource:

Please provide any additional information you would like to share about this incident below: