Confidential Report Form for Sexual Misconduct, Dating/Relationship Violence, Stalking

Your safety is of the utmost importance to South Central College. For information on resources, please visit the Sexual Violence Awareness, Reporting and Prevention Page of our website.

This form is intended for use by South Central College students, employees, vendors, visitors or other concerned individuals to report specific information related to incident(s) of Sexual Harassment, Sexual Assault, Sexual Exploitation, Dating/Relationship Violence, Stalking and other sexual misconduct.

This is a secure reporting format accessible only to the appropriate South Central College officials, including the Title IX Investigator and South Central College Security. You are not required to complete the entire form in order for the complaint to be submitted. The college will use the information provided to address the victim, which can include an investigation and contacting the victim, accused and/or any potential witnesses. If the report does not contain specific information, the college's investigation and response may be limited.

1Background > 2Incident Questions
Background Information

If you wish to identify yourself, please fill in the information listed below. If you are the victim, it is your choice whether to remain anonymous. However, please know doing so may limit the college's ability to address the matter and assist you. If you are a third party complainant who is not the victim, record your information below and record the victim’s name and contact information, with victim's permission, in the “Involved Parties” section.
Section Break

This is the description of your section break.
Your Full Name
Maximum of 60 characters allowed. Currently Entered: 0 characters.
Your Position Title
Maximum of 60 characters allowed. Currently Entered: 0 characters.
Your Email
Your Phone Your Phone - ### - ### ####
Your Home Address Your Home Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Incident Date Incident Date * / MM / DD YYYY
Incident Time Incident Time * : HH MM AM/PM
Specific Incident Location *
Must be between 10 and 500 characters. Currently Entered: 0 characters.

Confidential Report Form for Sexual Misconduct, Dating/Relationship Violence, Stalking

Confidential Report Form for Sexual Misconduct, Dating/Relationship Violence, Stalking

Background Information

Section Break