Sexual Harassment Incident Report - McPherson College Intranet

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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*
Date*
MM slash DD slash YYYY
Time

Hours :

Minutes

AM PM AM/PM
Nature of assault (check all that apply)*
- 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)*
- Residence Hall
- Off campus home/apartment
- Campus building
- Classroom
- Library
- Parking lot/car
- Other (please describe)
Affiliation to the victim (check all that apply)*
- 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?*
- 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
Name
This field is for validation purposes and should be left unchanged.

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