SAVP Anonymous Report Form
NOTE: Information included in this form goes privately to the Support, Advocacy, & Violence Prevention Office at Vassar College. No further action will be taken after receiving this form unless requested.
The following form collects information on incidents of sexual violence, sexual harassment, relationship abuse, or stalking. Anonymous reports are used to gather information about incidents of sexual assault and violence at Vassar College, and compiled data are used to inform the community about our campus climate.

If you would like to speak privately to a SAVP Advocate (formerly SART) now, please call (845) 437-7333 and ask for an advocate. Advocates are on call 24/7 and can provide information, support, and resources.

There is also an option for someone from the SAVP Office to reach out to you individually, if you would like. Please note that SAVP Director Nicole Wong will be departing her role at the college starting on April 1st. While the college hires a new SAVP Director, Erika Pappas (Director of Case Management) and Andrea Pesavento (Director of Health Promotion & Education) will be monitoring this form to ensure any student requesting support receives it.

All students are encouraged to formally report any incidents to Vassar College's Safety and Security Department (845-437-7333) or Title IX Coordinator (Rachel Pereira; 845-437-5334), as well as the Town of Poughkeepsie Police (911 o4 845-485-3666) if they wish to do so.
Your name:
*Non-responsible employees* may file this report anonymously. *Responsible employees should file a formal report with the Title IX office.
Email address:
Phone number:
Today’s Date:
MM
/
DD
/
YYYY
Affiliation with the Incident:
Clear selection
Type of incident(s):
Check those that apply.
Have you made any previous reports about this incident to either the Title IX office or any other responsible employees at Vassar College?
Clear selection
The following questions ask about the incident(s) that you are reporting. If any information is unknown, please leave the question blank.
Date of incident:
Include day/month/year, if known.
Approximate time of incident:
Victim/Survivor's gender:
Victim/Survivor's age:
Victim/Survivor's affiliation with Vassar:
Is there ongoing abuse?
Clear selection
Is drugging of the victim/survivor suspected?
If a specific drug is suspected, please enter information in the "other" section.
Clear selection
Alleged Perpetrator's gender:
Alleged Perpetrator's Age:
Alleged perpetrator's affiliation with Vassar:
Relationship of victim/survivor and alleged perpetrator:
Location of incident:
Did the incident occur at a Vassar College sponsored event?
Clear selection
OPTIONAL: Brief Description of the Incident:
Would you like the SAVP Office to contact you?
Clear selection
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