McPherson College Intranet – Sexual Misconduct Incident Report

This form may be completed by a member of the McPherson College community who has experienced or witnessed sexual assault, dating violence, domestic violence, and stalking on campus or during an off-campus activity. Unless otherwise specified, information given on this form will be used for statistical monitoring in compliance with the federal Student Right to Know and Campus Security Act only and will be kept confidential.

Filing this form will not result in an investigation unless the victim chooses to identify him or herself to an appropriate college official. There is no one way that victims of sexual violence respond to or heal from the trauma, although many do find that sharing their experience with a supportive listener and/or making an official report aided in their healing. Sharing this information may be helpful to the survivor in addition to the summary data shared with relevant offices on campus being useful in developing appropriate campus responses.

If you are a survivor or have witnessed sexual violence we urge you to contact: The Office of Student Affairs at (620) 242-0500 or 0501 (2500 or 2501 from campus phone) or the Director of Human Resources at (620) 242-0454 (2454 from campus phone). The Vice President of Academic Affairs may also take your call at (620) 242-0505 or 0506 (2505 or 2506 from campus phone).

Information on the assault*

Date*

Time

HH :

MM

Nature of assault (check all that apply)*

Location of assault (check all that apply)*

Residence Hall
Off campus home/apartment
Campus building
Classroom
Library
Parking lot/car
Other (please describe)

Affiliation to the victim (check all that apply)*

To your knowledge, was this incident reported to a police agency?*

Yes
No
Unknown

Any additional details concerning the incident that you believe we should know:

The VP for academic affairs, Dr. Clary, or the director of human resources, Brenda Stocklin-Smith, will confidentially follow-up with you.

I wish to remain confidential*

Yes
No

If no, please enter your email and/or phone number.

Email

Phone

Comments

This field is for validation purposes and should be left unchanged.