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Sexual Misconduct and Title IX
Office of Engagement and Enrichment

Sexual Misconduct Report Form

Form to Report Sexual Harassment, Sexual Assault, Dating Violence, Domestic Violence, Stalking, or Sexual Exploitation.

The University of Rochester is committed to providing a safe environment to work, learn, live, and socialize together without fear of sexual assault, harassment, or discrimination. Students, faculty, staff, visitors, and others can utilize the sexual misconduct report form – anonymously if preferred – to provide information about conduct or prohibited behavior(s) they have witnessed or experienced that violates University policies.

If you need immediate help

Review the below information prior to submitting your online report form.

About this form

The University of Rochester’s Title IX Coordinator reviews all submitted reports and retains the information in the Title IX Office. Please note that reports submitted using this form will be reviewed during University business hours and operations.

If the Affected Party/Complainant provides their name and contact information, a staff member from the Title IX Office will reach out to that individual and provide resources, support, and information on options and next steps. A report of conduct prohibited by Title IX is not the same as a formal complaint. A report, independently, does not automatically trigger a grievance procedure or investigation.

All employees, staff, and faculty of the University who do not serve in a Confidential Employee role (as defined in the University Title IX Policy), are Mandatory Reporters and are required to include their name and contact information in this form, and the name(s) of the disclosing individual, the name of the accused party (if shared), and other involved individuals.

Please note that Title IX Coordinators and Deputy Title IX Coordinators are private, but not confidential resources. They will address your submitted report with sensitivity and keep your information as private as possible.

Anonymous reporting

If you wish to remain anonymous, you may enter “anonymous” in the name field. While the University takes all reports seriously, our ability to take action on anonymous reports, depending on the information that is shared, will likely be limited and may be impossible.

In cases of anonymous reports for which we are unable to take action, the University will use the information shared for statistical purposes, to better understand the scope of sexual misconduct on campus, and to develop and implement preventive efforts.

Support services and resources

Please visit the pages below for additional information about:

Instructions

Please fill out the form below to the best of your ability. As indicated, you may select all options that apply to your situation for certain questions. You are not required to complete the entire form to submit. If you wish to remain anonymous, you may leave information fields blank.

If you have trouble accessing or using this form, please contact (585) 275-7814. You may also report the issue using the University’s contact form.

Sexual Misconduct Report Form

Form to Report Sexual Harassment, Sexual Assault, Dating Violence, Domestic Violence, Stalking, Sexual Exploitation, or related Retaliation to Title IX Staff at the University of Rochester.

Your Information

All fields marked with a red (Required) must be filled out.
Name
Email Confirmation?
Address
Students can provide their on-campus residential address. Employees can provide their on-campus working address.
University Affiliation (check all that apply)
Your Role

Describe what happened

What type of prohibited behavior took place? (Check all that apply). If you are unsure which category/categories describe what you are reporting, please select “unsure” from the list below. (Behaviors or conduct prohibited by the University as they relate to Sexual Misconduct are defined in policies which can be located on the University’s 'Policies' webpage).
Type of Behavior(s) that occurred(Required)
Please tell us about each separate act of prohibited behavior or conduct including specific time(s), date(s), and statements made; a timeline of events with relevant background information or information about any prohibited conduct; or the interaction you or the individual you are reporting on behalf of experienced. Include names of people involved (if known), and names of any witnesses (if known), and if any injuries were incurred, describe those injuries and whether you received any medical treatment.
Please list name, phone number (if known), email address (if known). If you are unable to identify those involved, you may enter “unknown” in the name field.
Accused/Respondent University Affiliation (check all that apply)(Required)
Please identify any additional individuals involved (parties and witnesses) including clubs/organization(s), if applicable:
If you have supporting documentation that you would like to include with your submission, please attach it here. This may include any or all of the following: photos, video, emails, recordings, screen shots, text messages, and other supporting documents. Attachments require time to upload, so please be patient while submitting this form.
Drop files here or
Max. file size: 20 MB.

    Date/Time and Location Information

    Select date MM slash DD slash YYYY
    Unsure of Date
    Time of incident or time of most recent incident (please estimate time if unsure)(Required)
    :
    Unsure of Time
    Location of Incident(s)(Required)

    Resources You've Contacted or Connected With

    What (if any) resources have you contacted in response to the conduct or situation? (Check all that apply).

    Submit the Report

    You will see a confirmation message on the screen when your report has been submitted.
    This field is for validation purposes and should be left unchanged.