Sexual Violence Anonymous Reporting Form
This form should be used by members of the University of Indianapolis community who have experienced or have been witness to sexual violence. The information will be used to identify and address troubling trends. If a perpetrator is named, a member of the Student Affairs Office will meet with that person to share that the person was named in an anonymous report, review the Sexual Misconduct Policy, and inform the person that if the allegations are true, the behavior needs to cease immediately. Information shared in this form alone will not result in anyone going through the grievance process.

If you are a survivor of sexual violence, there is help available. If you would like to report the incident, please contact the UIndy Title IX Coordinator, Anne Moelk at moelka@uindy.edu or 317-788-2139. If you would like to speak with a confidential resource, feel free to contact our Health and Counseling Center at 317-788-5015.

Date of Assault (if known)
MM
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DD
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YYYY
Time
:
What was the location of the assault?
What was the nature of the assault?
Please provide details of the incident.
Your answer
What is the name of the victim?
Your answer
What is the status of the victim?
What is the gender of the victim?
What is the status of the perpetrator (person who allegedly committed the act)?
What is the gender of the perpetrator(s)? If more than one, add in "other".
What is the name of the perpetrator(s)?
Your answer
If you are not the victim, how did you learn of this incident?
If you would like someone to contact you regarding this incident, please add your name and contact information here.
Your answer
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