Anonymous Reporting Form for Sexual Misconduct, Harassment, Discrimination or Retaliation
This form should not be used to report immediate threats. For emergency assistance, please call 911.
Reporting Party
This portion is for the individual completing the form and is optional.
Name
Your answer
Email Address
Your answer
Phone Number
Your answer
Mailing Address
Your answer
Relationship to Barton Community College
Incident
Are you also the survivor (or victim) of the incident?
If you are not the survivor (victim), how did you learn of the incident?
Date of Incident
Leave blank if unknown
MM
/
DD
/
YYYY
Location of Incident
Your answer
Survivor (Victim) Information
This section is optional.
Name of Survivor (Victim)
Your answer
Gender
Your answer
Age
Your answer
Relationship to Barton Community College
Accused (Perpetrator) Information
This section is optional. If you choose to complete this section, please provide any known information.
Name of Accused (Perpetrator)
Your answer
Gender
Your answer
Age
Your answer
Relationship to Barton Community College
Approximate Height
Your answer
Approximate Weight
Your answer
Clothing
Your answer
Distinctive Marks or Scars
Your answer
Facial Hair
Your answer
Glasses
Your answer
Hair Color
Your answer
Length of Hair
Your answer
Piercings
Your answer
Race or Ethnicity
Your answer
Tattoos
Your answer
Weapon Involved
Your answer
Were there multiple offenders?
If so, provide similar descriptions for additional offenders below.
Your answer
Incident Details
Please provide details of the incident.
Your answer
Is the survivor (victim) planning to report to legal authorities (or has already reported)?
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