Reporting Sexual Assault

This electronic report may be used by students, employees, faculty, staff, vendors, visitors or other concerned parties to report information related to an alleged incident(s) of sexual discrimination, harassment or misconduct. Sexual misconduct includes, but is not limited to, sexual assault, sexual exploitation, dating violence, domestic violence, sexual violence and stalking. This electronic reporting system should not be used in emergency situations. If this is an emergency, please call 911.

This is a secure reporting format accessible only to the appropriate college officials. You are not required to complete the entire form in order for the complaint to be submitted. The college will use the information provided to address the concern, which may serve as notice to the College to begin an investigation. An investigation generally includes contacting the reporter and/or complainant first and then contacting the respondent and any potential witnesses. If the report does not contain sufficient information regarding the complainant or respondent, the college’s investigation and response may be limited.

You may access information about reporting options, resources available to assist you including interim protective measures, and complaint resolution procedures by visiting the Student Guide to Addressing Sexual Harassment and Sexual Misconduct Section of the online Student Handbook.

Information Regarding Complainant - Individual who experienced sexual discrimination, harassment or misconduct

If you wish to identify yourself, please provide the information requested below. You may choose to remain anonymous.

Name:

Phone number:

Email address:

Relationship with Lake Land College:

Information Regarding Reporter - Individual reporting the incident(s)

If you are making this report on behalf of someone else, please complete the information below.

Name:

Phone number:

Email address:

Relationship with Lake Land College:

Information Regarding Respondent(s) - Individual(s) the complaint is against

Please provide any details known.

Name:

Phone number:

Email address:

Relationship with Lake Land College:

Any additional details:

Information Regarding Incident(s)

* Indicates a required field.

Date of incident: *

Time of incident:

Location of incident (If on campus, please provide specific building and room number if available):

Description of incident - Please provide as much detail as possible: *

Potential Witnesses to the Incident(s) and Others with Knowledge of the Incident(s)

Please include the name and any known details for each:

Name:

Phone number:

Email address:

Relationship with Lake Land College:

Any additional details:

Was a police report filed about the incident(s)?
No Yes
Have you discussed the incident(s) with any college official?
No Yes

If so, whom?

Consent and Spam Filter

* Indicates a required field.

After submission of this form, you will receive an email acknowledgement with additional information regarding resources available to assist you immediately and resources to follow-up with at Lake Land College. If you have provided your contact information, a college staff member will follow-up with you on the next business day.

By checking the box below and submitting this form, you certify that the information you have provided is true and accurate to the best of your knowledge.

I agree *

Spam Filter *

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