Sexual Harassment Incident Report
URL
This field is for validation purposes and should be left unchanged.
This form may be completed by a member of the McPherson College community who has experienced or witnessed quid pro quo sexual harassment, hostile environment sexual harassment, sexual assault, dating violence, domestic violence, and stalking on campus or off-campus in any campus housing or educational program or 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 Dean of Students at (620) 242-0503 or -0506 (2503 or 2506 from campus phone).
Information on the assault
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Date
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MM slash DD slash YYYY
Time
Hours
:
Minutes
AM
PM
AM/PM
Nature of assault (check all that apply)
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Sexual contact (intentional touching of intimate parts or clothing covering intimate parts for the purpose of sexual arousal or gratification) without consent.
Penetration (sexual intercourse, cunnilingus, fellatio, anal intercourse, any other intrusion of a body part of an object into genital or anal openings) without consent.
Attempted penetration
Dating or Domestic Violence
Stalking
Verbal pressure/arguments
Physical force
Abduction
Presence of Weapon
Threat of physical force or harm
Threat of harm to family or friends
Victim under 18
Threat of negative social, academic, or employment consequences
Victim asleep
Gave victim drugs and/or alcohol
Position of authority (boss, professor, etc.)
Other (please explain below)
Location of assault (check all that apply)
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Residence Hall
Off campus home/apartment
Campus building
Classroom
Library
Parking lot/car
Other (please describe)
Affiliation to the victim (check all that apply)
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partner/lover
friend/acquaintance
roommate
family member
stranger
just met
professor
advisor
supervisor
colleague/co-worker
staff
student
To your knowledge, was this incident reported to a police agency?
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Yes
No
Unknown
Any additional details concerning the incident that you believe we should know:
The dean of students, Dan Falk, or the dean of faculty, Matt Skillen, 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