Sexual Misconduct Reporting Form Notes on Confidentiality All submissions are reviewed and investigated. Individuals with complaints of this nature also always have the right to file a formal complaint with the United States Department of Education. Department of Education Offices for Civil Rights (OCR) 400 Maryland Ave. SW Washington, DC 20202-1100 Customer Service Hotline: 1-800-421-3481 Fax: 202-453-6012 TDD: 877-521-2172 Email: ocr@ed.gov Web: http://www.ed.gov/or Confidentiality If you desire that the details of the incident be kept confidential, you may speak with one of our staff members in the Wellness Center in Lenfest Commons which includes our college counselors, college nurse, and our college chaplain, and/or you may also choose to reach out to our local crisis agency, Women In Need (WIN) at www.winservices.org or 1-800-621-6660. Resident Assistants (RAs), faculty, and other student life staff are obligated to report all incidents of sexual misconduct in order to comply with federal requirements. This reporting does not require specific names, and without names, no detailed investigation can follow. You are encouraged to speak to college officials to make formal reports of all incidents of sexual misconduct including residence life staff, deans, faculty, campus safety, human resource staff, and other college staff. The college considers these members of the college community to be responsible employees, and speaking with them is considered giving notice to the institution. You have the right, and can expect to have all incidents of sexual misconduct to be taken seriously by the college when formally reported, and once reported, all incidents will be investigated and properly resolved through administrative procedures. Your Information Enter your first and last name, the person reporting this event. (optional) Email (optional) Cell phone (optional) Wilson College is committed to addressing the issues of sexual harassment, gender discrimination and sexual violence. We need and appreciate your sharing critical incidents or concerns with us. This confidential web form is designed to receive information pertaining to any specific incident or concern. Information Related to the Incident Location of the incident Date of the incident Time (can be approximate) Please indicate the type of sexual misconduct. Check all that apply. Attempts at non-consensual contact (threat, intimidation) Non-consensual contact (touching) Non-consensual sexual intercourse Sexual exploitation (non-consensual video or audio-recording of sexual activity, voyeurism, etc.) Sexual harassment (unwelcome, gender-based verbal or physical conduct) Stalking Domestic violence Dating violence Other Attempts at non-consensual contact (threat, intimidation) contact Basic information required to submit a complaint. Required information regarding the alleged victim Gender of the alleged victim. (The person allegedly to be the victim of the act>) - Select -MaleFemale Select the choice that best represents the alleged respondent (same as above): Wilson student Faculty or staff Non-student, community member Visitor Any other individuals involved? If so please indicate how many and their respective gender(s) Detailed Information (optional) First and Last name of the alleged victim. (The person allegedly to be the victim of the act) The first and last name of the respondent. (The person allegedly to have committed the act.) Describe in detail the incident, including the names of potential witnesses. If you have other documentation or information you would like to share, please contact Human Resources or the Dean of Students or by emailing TitleIX@wilson.edu Information submitted in this area will result in further investigation by the college. Submitting the report I understand and I pledge that the information submitted is accurate, to the best of my knowledge. Please check the box below. Checking the box below will confirm that you understand that all reports will be reviewed. Confidentiality is an important value; however, the college has an obligation to interview individuals or review organizations and events that might violate college policy and create an unsafe environment. Submit Leave this field blank
