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University of Lynchburg Interpersonal Misconduct Reporting Form
The University of Lynchburg is committed to addressing incidents of interpersonal misconduct. Interpersonal misconduct includes sexual misconduct (non-consensual sexual intercourse/contact, sexual exploitation or sexual harassment), dating violence, domestic violence and stalking.

The University of Lynchburg appreciates your help in bringing such incidents to our attention. This form can be completed by either victims of interpersonal misconduct-related incidents or witnesses to them. Please include as much information as possible. Reports are secure and private in nature. Only certain designated University officials have access to the information contained in these reports. Please include your full name and contact information at the conclusion of this form.

The full University of Lynchburg interpersonal misconduct Policy is available at the following link:

For more information on what to do in cases of sexual misconduct, see the image at the bottom of the form.

Thank you

Email address *
Your Name
Your answer
Address
Your answer
Phone Number
Your answer
Classification
Date of Incident
MM
/
DD
/
YYYY
Time of Incident
Time
:
Location of Incident
Your answer
Detailed Description of Incident (please include all pertinent facts, behaviors, and comments including the full names of all of the individuals involved)
Your answer
Please provide your contact information and the best time to contact you.
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