Sexual Misconduct Report Form - Gonzaga University

SEXUAL ASSAULT: Any non-consensual touching, without penetration, of the sexually intimate parts of another person without her/his consent or permission

Acquaintance assault

Stranger assault

SEXUAL EXPLOITATION: Taking unjust or abusive advantage of another person for the Accused’s own purposes or benefit (the behavior is not rape or sexual assault); sexual exploitation can be any of the following:

Stalking: repeated, unwanted contact that causes reasonable apprehension of imminent physical harm or substantial impairment of the person’s ability to perform daily activities. (The reporting party reasonably believes that the stalker’s conduct has a sexual motivation.)

Voyeurism: To trespass, spy or eavesdrop (including electronically) with what a reasonable person believes to be a sexual motivation. This conduct is unsolicited and unauthorized by the Reporting Party.

Videotaping or photographing of any type (web-cam, camera, internet exposure, etc) of sexual activity without knowledge and consent of all persons.

Inducing incapacitation with the intent to commit rape or sexual assault (regardless of whether sexual activity actually occurred). This includes the use of any type of medication (prescription or over the counter), other drug, alcohol, or substance.

Knowingly transmitting HIV or STD to a person who is unaware and/or has not consented to the risk. This may occur by recognized means of transmission but is not limited to sexual contact.

INCIDENT INFORMATION:

Date of incident: \ \ Time of incident:

Location of incident: On-Campus Off Campus

Building name or general location:

The following information will not be used to try to determine the identity of the Reporting Party or the Accused, although you may provide it voluntarily

REPORTING PARTY INFORMATION:

Gender of Reporting Party
Academic Year of Reporting Party Age of Reporting Party at time of incident

Resident student Off-campus student Non-student

Did the Reporting Party sustain any non-sexual injuries such as cuts, abrasions, bruises? Yes No

Has the Reporting Party sought medical attention? Yes No

(This question is optional) Was Reporting Party under the influence of alcohol or other drugs at the time of the incident? Yes No

If the incident occurred in a dating relationship, is there a history of violence or abuse? Yes No

Does the reporting party believe he/she is in any physical danger from accused or others? Yes No

Did the Reporting Party file a report with a police or security department? Yes - Date: \ \ No

ACCUSED INFORMATION :

Gender of Accused
Academic Year of Accused Age of Accused at time of incident (if known)

Resident student Off-campus student Non-student Unknown

Did the Accused sustain any injuries during the incident? Yes No Unknown

Was the Accused under the influence of alcohol or other drugs at time of incident? Yes No Unknown

Do you want to give the name of the Accused? Yes: No

This report was completed by: The Reporting Party Another person on behalf of the Reporting Party

Date this report was completed: \ \

DESCRIBE WHAT OCCURRED: