EmailMeForm
Reporting Area
(Choose One):
*
Student Affairs
Residence Life
Athletics
Campus Life
Other
Type of Criminal Offense:
*
Date & Time of Incident:
*
MM
/
DD
/
YYYY
HH
:
MM
AM
PM
AM/PM
Incident Location:
*
On Campus
Residential Facilities
Non-campus building or property owned, controlled, or leased by a student organization or the university, but not on campus.
On public property adjacent to the university, but not on the university, such as sidewalks, streets, thoroughfares, or parking facilities.
Other
Did the victim perceive
they were selected
because of (choose one):
*
Race
Religion
Gender
Sexual Orientation
Ethnicity
Disability
N/A
Brief Description
of Incident:
*
Was incident reported to law enforcement?
*
Yes
No
If “Yes” what law enforcement agency
was it reported to:
Victim Information:
*
Student
Staff
Faculty
Non-Affiliate
Unknown
Assailant/Perpetrator Information
(check all that apply):
*
Morgan Student(s)
Non-Morgan Student(s)
Stranger(s)
Acquaintance(s)
Unknown
Was the victim referred to you from (choose one):
*
Police
Residence Life
Student Affairs
Faculty/Staff
N/A
Other
Person Completing Report
Name
*
First
Last
Title
*
Date
*
MM
/
DD
/
YYYY
Phone
*
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