Sexual Misconduct Report Form

Please use this form to make a report of sexual misconduct.  You can anonymously report an incident by choosing to leave out your name, or the names of others involved.  Please be aware that leaving out names may limit how the university can deal with reports of sexual misconduct, but will not negatively affect the support and resources given to those who report sexual misconduct.  For more information specific to what constitutes sexual misconduct at Gonzaga University, please see the Student Handbook at www.gonzaga.edu/studenthandbook.  If you would like to learn more about other reporting options, please click on the reporting options tab on the left. 
Do Not Edit:
Do Not Edit:
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Date of the incident (mm/dd/yy):
Time of the incident (am/pm):
Location of the incident (optional):
Your name (optional):
Would you like the Gonzaga SART (Sexual Assault Response Team) first responder to contact you regarding supportive resources and information? Yes No
If so, please provide a phone number or email address where we can reach you or leave a message (You can speak to a SART member anonymously over the phone, or in person.):
Are you the person who experienced the misconduct (the "Reporting Party")? Yes No
Your Gender: Female Male
Your age:
Your year in school (FR, SO, JR, SR, GRAD, OTH)
If you are not the Reporting Party (the person who experienced the misconduct), please provide the following information for that person:
Gender: Female Male
Age
Year in school:
Please provide the following information about the person who is committed the misconduct (the “Accused”). Please note that if you provide the name the University may contact that person to follow up on the incident. You may also request that the university not follow up with the accused, we will take that into consideration. If you do not provide the name the University’s ability to follow up and potentially take action is limited.
Name (optional):
Gender: Female Male
Age:
Year in school:
Description of incident:
Did the Reporting Party sustain any injuries? If so, please describe:
Did the Reporting Party seek medical attention? If yes, please explain:
Did the Accused sustain any injuries? If yes, please explain:
Was alcohol and/or drugs involved in this incident? Was either party under the influence of alcohol and/or drugs?
Is/was there a current or previous relationship between the Reporting Party and the Accused?
Did the Reporting Party contact other University offices or outside agencies? If so, please describe (Student Life, SART, Campus Security, Spokane Police, Hospital, SafeT, Lutheran Social Services)
If the Reporting Party sought medical treatment at a hospital, was a rape kit done for a criminal investigation?
Would the Reporting Party like to recieve a packet of resources for victims of sexual misconduct? If so, where can we send the packet?