Online Incident Report Form

This form is to be completed by University of Kansas faculty and staff who are mandatory reporters and by students or guests of the University of Kansas who witness or become aware of incidents of harassment, discrimination, and/or sexual misconduct, sexual assault, or sexual violence.

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Please review the marked fields below.

Contact Information of Person Reporting the IncidentIt is permissible to report anonymously and leave this section blank.
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Type of Incident Alleged

Please check all that apply.

Complainant Contact Information

Name of person allegedly harassed, discriminated against, or victim of sexual misconduct, sexual assault or sexual violence.

(First Last)
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Respondent Contact Information

Name of person who allegedly engaged in harassment, discrimination, or sexual misconduct, sexual assault or sexual violence.

(First Last)
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Description of Incident
Witness Contact Information

Witness #1

(First Last)
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Witness #2

(First Last)
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