Sexual Assault Anonymous Reporting Form

This form requests information that will help the University monitor and respond to incidents of sexual assault and misconduct. The form can be used to describe a range of sexually violating behaviors including inappropriate touch, stalking, harassment, misconduct, and rape. Information obtained from these forms will be compiled and shared with campus and community professionals who provide victim services and/or prevention services.

These compiled reports will not contain any names or any other information that might compromise the victim's identity. The data will be used to target prevention efforts and to assist survivors. Response to any and all items is optional. There is no penalty for failing to respond to requested information.

Instructions: Please Complete the items you feel comfortable answering.

Victim Profile

Gender

Race

Age

Is the victim a UNI student? Yes No

Victim's classification at time of assault:

Date of abuse

Approximate time of abuse

Location of abuse (e.g. victim's dorm room)

Cell Phone:
Contact:

Profile of Assailant(s)

Number of assailants