Sexual Misconduct Reporting Form

Reporter and Incident Information

Please use this section to provide us with your contact information and the date/location of the incident(s).

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Your full name:

Your phone number:

Email Address to Contact You:

Email address must be of a valid format.

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This does NOT have to be your NU email. If an email is provided here you will receive an auto-reply

Your Northwestern Connection(Required):

This field is required.

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In what capacity you are submitting this report?

Date of incident(Required):

This field is required.

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If unknown, please choose today's date and state

Time of incident:

Location of incident(Required):

This field is required.

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If unknown, choose Unknown/Other

Specific location:

Involved Parties

Please provide information for all people and/or organizations that are involved in this situation, including yourself.

When selecting the “Role” for each individual you include below, please refer to the following definitions:

Subject of Concern: a person or organization who is the subject of the report because they are alleged to have violated University policy.
Complainant/Impacted Party: an individual impacted by the actions of another person or organization, particularly if those actions are alleged to have violated University policy.
Person with Information: an individual who has information about the reported situation, or the persons involved in it, whether or not they directly observed the situation.
Other: other

Name or Organization

Select Gender

Select Role

NUID Number

DOB (YYYY-MM-DD)

Phone number

Email address

Description of the Concern

Please describe what has occurred.(Required) This field is required.

Providing additional information on why you are submitting this report will allow us to respond most appropriately (for example: I want the University to know. I am looking for resources or support. I am concerned for the student. I would like the person held accountable.) This field is required.

Please share with us your pronouns (e.g., ‘she-her-hers’ or ‘they-them-theirs’) so that we can use appropriate references in any future communications with you. This field is required.

Sexual Misconduct Reporting Form

Reporter and Incident Information

Involved Parties

Description of the Concern

Related Documentation

Submission