Anonymous Reporting Form

The University of North Texas System Administration is committed to maintaining an environment free from sexual assault and retaliation. Conduct that is inconsistent with this commitment will not be tolerated at any location, program or other activity associated with the UNT System.

This form is for any faculty, staff or student who have knowledge or reasonable suspicion that an incident of sexual assault, dating violence and-or stalking has taken place. Reporters and survivors may request to remain anonymous; however, the UNT System still wants to be notified of any incidents of sexual assault, dating violence and stalking.

For further information about this form, including definitions and what this information will be used for, please go to the Sexual Assault Anonymous Reporting page.

PLEASE BE AWARE: Completing this form does not constitute a police report or a misconduct report. To file a formal complaint please contact the UNT System Office of Equity, Diversity and Inclusion at hrs.eo@untsystem.edu, or call 817-735-0614.

Any information contained in this completed form will remain confidential unless applicable federal and state laws require certain disclosures.

Other Campus Reports

Find and submit an anonymous report of sexual assault or misconduct at another System location:

Please direct questions to the Office of Equity, Diversity and Inclusion via email at HRS.EO@untsystem.edu or by calling 214.571.2425 or 214.571.4929.

Today's Date *

Month

Day

Year

Reporter's Name (optional)

Please contact

I (the reporter) would like to be contacted by someone from the following UNT System Offices (please check all that apply)

Equal Opportunity Compliance Officer

Title IX Coordinator

I don't want to be contacted

Phone Number

Incident Details

Nature of Report *

Date of Incident *

Month

Day

Year

Time of Incident

Hour

Minute

Location of Incident

Was incident previously reported to a campus department or external agency? *

Please identify the department or external agency informed and the date notified: *

Victim

Victim(s) Name (optional)

Gender of Victim *

Has the victim received any additional resources (i.e. counseling or medical attention)?

Victim's Affiliation to UNT System *

Assailant(s)

Name of Assailant(s)

Gender of Assailant(s)

Assailant(s) Relationship to Victim

Other *

Assailant(s) affiliation to UNT System

Use of Alcohol or Drugs

Assailant(s) Use of Alcohol or Drugs

If alcohol and/or drugs were involved, did the victim feel pressure to consume or use?

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Other Campus Reports