Anonymous Incident Information
Date of Incident Time
Place of Occurrence
(An address is preferred, but if it occurred at the victim's home, a residence hall,
other college area, off campus or street coordinates are acceptable.)
Physical Description/Distinguishing Characteristics
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(Include Odors, Scars, Tattoos, Facial Hair, Speech Impediments, Etc.)
Were You physically injured?
If Yes, please describe the extent and nature of your injuries in detail
Manner of initial contact (I.E.: Came to victim's door, attacked on
What did the suspect say before, during and after the assault?(Please be
as specific as possible)
Do you plan to make a formal report to the police?
If no, why have you chosen to make an anonymous report
rather that make a
formal report to the police?
Please give a narrative of the sexual assault(Please provide as much
detailed information as possible)