SAVP Anonymous Report Form
NOTE: Information included in this form goes privately to Nicole Wong (nicwong@vassar.edu), Director of the Sexual Assault and 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 assault, 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 SART advocate now, please call (845) 437-7333 and ask for SART. Advocates are on call 24/7 and can provide information, support, and resources.

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.
Your answer
Email address:
Your answer
Phone number:
Your answer
Today’s Date: *
MM
/
DD
/
YYYY
Affiliation with the Incident: *
Type of incident(s): *
Check those that apply.
Required
Have you made any previous reports about this incident to either the Title IX office or any other responsible employees at Vassar College? *
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.
Your answer
Approximate time of incident:
Your answer
Victim/Survivor's gender:
Your answer
Victim/Survivor's age:
Your answer
Victim/Survivor's affiliation with Vassar:
Is there ongoing abuse?
Is drugging of the victim/survivor suspected?
If a specific drug is suspected, please enter information in the "other" section.
Alleged Perpetrator's gender:
Your answer
Alleged Perpetrator's Age:
Your answer
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?
OPTIONAL: Brief Description of the Incident:
Your answer
Would you like the SAVP Director, to contact you? *
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