Section I - Who is filling out this form?
First Name
Last Name
Email
Phone
Section II - What happened?
Type of complaint
Sex/gender-based discrimination
Sex/gender-based harassment
Sexual harassment
Sexual Assault
Intimate Partner Violence
Stalking
Sexual Misconduct
Retaliation
I don't know how to categorize this complaint
Date of incident
Time of incident
Location of incident
Description of incident
Witness names and contact information
Were police notified?
Yes
No
Unknown
Was medical care required or received?
Yes
No
Unknown
Does evidence exist (e.g. texts, photos, video)?
Yes
No
Unknown
Section III - Who do you believe was harmed?
Person you believe was harmed
What is their affiliation with Bradley University
Student
Faculty
Staff
Other
Unknown
Additional persons who you believe were harmed
Section IV - Who do you believe caused the harm?
Person you believe caused harm
What is their affiliation with Bradley University
Student
Faculty
Staff
Other
Unknown
Additional persons who you believe may have caused harm
Section V - Additional Information
Is there anything else you would like us to know?
Contact Information