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Anonymous Reporting
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Anonymous Reporting
Today's Date
*
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Month
Day
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Day
Year
2017
2018
2019
2020
2021
Year
Reporter's Name (optional)
Nature of Report
*
- Select -
Sexual Assault
Dating Violence
Stalking
Victim(s) Name (optional)
Gender of Victim
*
Male
Female
Victim's Affiliation to UNT System
*
Staff
Not Affiliated
Other
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
Email
Name of Assailant(s)
Gender of Assailant(s)
Male
Female
Multiple Males
Multiple Females
Males and Females
Unknown
Assailant(s) Relationship to Victim
Partner, girlfriend or boyfriend
Friend
Ex-partner, girlfriend or boyfriend
Faculty
Teaching Assistant
Staff Member
Work Supervisor
Colleague or Co-worker
Acquaintance
Stranger
Other
Assailant(s) Use of Alcohol or Drugs
Used Alcohol
Used Drugs other than Alcohol
Unknown Whether Drugs or Alcohol Were Used
Assailant(s) affiliation to UNT System
Student
Faculty
Staff
Not Affiliated
Unknown
Other
Date of Incident
Month
Jan
Feb
Mar
Apr
May
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Jul
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Nov
Dec
Month
Day
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Day
Year
2017
2018
2019
2020
2021
Year
Time of Incident
*
Hour
1
2
3
4
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10
11
12
Hour
:
Minute
00
01
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59
Minute
am
pm
Location of Incident
Workplace
UNT System Building
Car of Vehicle
Outdoors
Parking Lot
Was Victim given alcohol and/or other drugs without consent or knowledge?
Yes alcohol
Yes drugs
No
Unknown
If alcohol and/or drugs were involved, did the victim feel pressure to consume or use?
Yes
No
Was incidnet previously reported to a campus department or external agency?
*
Yes
No
Unknown
If yes, please identify the department or external agency informed and the date notified:
Please provide a detailed description of the incident:
*
Has the victim received any additional recources (i.e. counseling or medical attention)?
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