Relationship Violence, Sexual Misconduct, and Stalking Reporting Form

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 the Title IX Office at 906-227-2420.

Reporter Type

I am a

Are you the complainant (the individual who is allegedly subjected to behavior that violates the Relationship Violence, Sexual Misconduct, and Stalking Policy) in the situation being reported?

Yes

Incident

Reporter's Name

Reporter's Email

Reporter's Phone

Date of Incident

Time of Incident

The situation you are reporting involves (select all that apply):

(Please refer to the Glossary of Terms in the Relationship Violence, Sexual Misconduct and Stalking Policy for the terms listed below.)

Sexual assault

Dating/domestic violence

Sexual harassment

Stalking

Sexual exploitation

Sexual or gender-based harassment

Involved Individual(s)

(Please list the full name individual(s) that are involved in the incident you are reporting.)

Location of Incident

(Please briefly describe where the incident occurred.)

Incident Description

(Please describe what occured.)