Sexual Misconduct Reporting Form

Basic Information

You have the ability to submit this form anonymously by omitting your name, Mines email address, or other identifying information. Please note: an anonymous submission may impede the Office of Institutional Equity & Title IX from being able to fully address the concern.

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Your full name:

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Person reporting issue

Your position/title:

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Student? Faculty? Staff? RA?

Your phone number:

Your email address:

Email address must be of a valid format.

Nature of this report(Required):

This field is required.

Date of incident(Required):

This field is required.

Time of incident:

Location of incident(Required):

This field is required.

Specific location:

Involved Parties

Please list as much information as possible about each party involved in the incident.

Name, Department, or Organization

Select Gender

Select Role

Phone number

Email address

Hall/Off-Campus Address

Questions

Please share what happened. (You are able to share as much or as little as you feel comfortable.)(Required) This field is required.

Please indicate if you have any safety concerns for either yourself or another person. This field is required.

Please indicate what other offices and/or individuals have been made aware of the incident. This field is required.

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Email me a copy of this report

Basic Information

Involved Parties

Questions

Supporting Documentation

Submission