UMR Sexual Misconduct Concern Form

Reporting Person and Incident Information

We do not require that you share your name and contact information with us; however, without this information, we will likely be limited in what we can do to follow-up on the concern. Please note that to best support you, address the behavior of the person of concern and to protect our community, we typically need follow-up and clarifying information from the reporting person. We encourage you to share your name and contact information. UMR faculty, staff and Resident Assistants MUST IDENTIFY THEMSELVES when submitting a sexual misconduct concern form.

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Your full name:

Your phone number:

Your email address:

Email address must be of a valid format.

Nature of this report(Required):

This field is required.

Person or group of concern(Required):

This field is required.

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The person or group ABOUT whom you are reporting a concern, not yourself

Date of incident (approximate)(Required):

This field is required.

Location of incident(s)(Required):

This field is required.

Specific location:

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Additional location details (room number; building, etc.)

Involved Parties

Please list the person(s) or organization(s) of concern. Please note that if we do not know the person of concern's name, we will be limited in how we can respond. However, our priority is to first try to help the impacted individual.

Person(s) of Concern Name or Organization of Concern

Incident Description

Please provide a brief, concise narrative of your concerns about the incident(s) you have experienced, observed or been informed of. There is no need to provide all the details at this time, though welcome. A brief synopsis is only needed now, and additional information can be provided in a follow-up conversation.(Required) This field is required.

As a Reporter, I agree with the following:(Required)

I would like some follow-up because I need some information and advice on self care, helping person of concern, resources, etc., and I understand I may need to provide additional information on the incident/concern. I do not need any follow-up for advice or self-care, but understand that I may need to be contacted for more information. I do not want to provide any additional information, and understand that the University may be limited in next steps without additional information and follow-up from me.

This field is required.

Supporting Documentation

Please attach any relevant documents that may supplement the description above. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Email me a copy of this report

Reporting Person and Incident Information

Involved Parties

Incident Description

Supporting Documentation

Submission